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The Clinical Significance of Oral Fluconazole Prophylaxis Against Invasive Fungal Infection in Preterm Neonates with Peripherally Inserted Central Catheters

Author: BaoZuo
Tutor: DuLiZhong
School: Zhejiang University
Course: Pediatrics
Keywords: Premature children Invasive fungal infections Catheter-related infections Fluconazole Cholestasis
CLC: R722.6
Type: Master's thesis
Year: 2009
Downloads: 26
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Abstract

Objective: With the deepening of research of nosocomial infections, neonatal intensive care unit (NICU) management has become increasingly important. Just lost the maternal protection of the external environment adaptability poor, weak immunity against the disease, the physiological function is not yet ripe for premature infants, nosocomial infection is one of the common hazards. Many studies show that since the implementation of the peripheral venous puncture central venous catheter (PICC) has been widely carried out in the NICU, the incidence of nosocomial infection improved significantly over the previous. Catheter-related infections, mold is a major pathogen, increased mortality and morbidity of preterm children. Common clinical manifestations of invasive fungal infections has no characteristic often susceptible to primary disease or secondary bacterial and viral infections concealed, coupled with traditional fungal culture positive rate was low, so early diagnosis is very difficult. Therefore, it is particularly important to take effective means to prevent fungal infection. Previous studies focus on how to prevent invasive fungal infections avoid the use of broad-spectrum antibiotics, evacuation fungal infections instruments fine, until recently, only more and more on the use of fluconazole to prevent very low birth weight infants fungal colonization and invasive fungal infections reported. In adult patients, children and patients with hematologic malignancies or immunodeficiency diseases, prophylactic use of fluconazole is OK, but especially in the newborn very low birth weight infants in the ability of fluconazole to prevent invasive fungal infections still has a big controversy. In this study, by gestational age at birth ≤ 32 weeks and / or birth weight ≤ 1500 g the PICC catheter premature children 1,3,6,9,12 days of the catheter and the catheter two weeks after every oral fluconazole tablets a day, dose 6mg/kg., until unplug the PICC catheter explore fluconazole in invasive fungal infections in the prevention of deep venous catheter preterm children clinical significance. Method: Select the object Zhejiang University Affiliated Children's Hospital neonatal intensive care unit premature infants hospitalized between January 2006 to June 2009 to a total of 224 cases, 114 cases of male, female 110 cases. Cases selected conditions: (1) gestational age at birth ≤ 32 weeks and / or birth weight ≤ 1500 g. (2) admission during home the PICC children. A retrospective, non-randomized, double-blind analysis method, from January 2006 to December 2007, the study did not take the prophylactic use of fluconazole, known as pre-exposure prophylaxis period (PPE, pre-prophylaxis era) children study between January 2008 to June 2009 using the prophylactic use of fluconazole, said prevention phase (PE, prophylaxis era) children. SPSS 11.5 statistical software package for statistical analysis, comparing the two groups of children with the basic clinical characteristics, the analysis of the two groups of patients the incidence of invasive fungal infections and other complications of premature children including BPD, NEC, IVH, ROP compared . Conventional biochemical indicators collected two groups of patients, the study of fluconazole application whether children with liver function damage and the presence of increased incidence of cholestasis. Results: The diagnostic criteria refer to patients with severe invasive fungal infection diagnosis and treatment guidelines \. \All PPE group confirmatory diagnostic criteria for invasive fungal infections diagnosis of invasive fungal infections in children are related to clinical manifestations, and the air sucked out under endotracheal intubation patients based blood culture and aseptic tract secretions positive culture results, consider fungal sepsis and fungal pneumonia; 3 patients blood cultures and PICC catheter tip cultures were positive for the same kind of mold, the diagnosis of catheter-related fungal sepsis; patients PICC catheter tip culture positive blood culture negative, but the combination of the diagnostic criteria for the clinical diagnosis of catheter-associated invasive fungal infections; cases of invasive fungal pneumonia in children, clinical and x-ray of a lung infection during hospitalization performance in aseptic endotracheal intubation suck out secretions positive culture results, combined with antibiotic therapy in children with effective anti-fungal drugs, it is a clinical diagnosis; another three cases were tied with a typical clinical presentation, broad-spectrum antibiotic treatment ineffective Although there is no positive culture results, but the combination of children with symptoms and signs of anti-fungal medication improved in line with the suspected invasive fungal infections standards. PE group children Preventive fluconazole oral treatment was 17.13 ± 0.95 days, no case of children with a fungal infection. The two groups compared, P values ??<0.05, statistically significant, that oral fluconazole can effectively prevent the premature children catheter-related invasive fungal infections. Will adopt the prophylactic use of fluconazole in children alanine aminotransferase PPE group were compared, did not significantly improve between the two groups the incidence of cholestasis also no significant differences. Fungal culture positive rate is low and the number of cases of this study is limited, oral fluconazole would produce resistant strains has not been a clear conclusion. Conclusion: birth gestational age ≤ 32 weeks and / or birth weight ≤ 1500 grams, with the PICC catheter premature children, the use of oral fluconazole in preventing invasive fungal infections. Oral fluconazole for premature children without evident hepatotoxicity, and will not increase the incidence of cholestasis. Oral fluconazole does not increase the incidence of other complications of premature birth. 4. Oral fluconazole produce resistant strains and the presence of other long-term side effects needs further study.

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