Profilaxia com fluconazol em pré-termos extremos colonizados por Candida e sua associação com candidemia invasiva

Abstract

Introduction: The incidence of candidemia in neonatal units has been increasing in the last decades with high morbidity and mortality, making new diagnoses and treatments necessary. In an attempt to reduce cases of invasive candidemia, prophylaxis with fluconazole in premature newborns has been strongly discussed nowadays. Methods: A retrospective study was performed with analysis of electronic medical records from January 2014 to May 2019 in 46 extremely premature infants with birth weight less than or equal to 1000g at a Hospital in the interior of São Paulo. Surveillance cultures for Candida; use of prophylactic fluconazole (according to the unit's protocol) and its association with mortality, morbidity, incidence of invasive candidemia, epidemiological, clinical and therapeutic aspects were analized. Results: Bivariate analysis of risk factors - third generation cephalosporins, third generation antibiotics and the use of histamine blockers were associated with the development of candidemia. Of the total that received prophylactic fluconazole, three newborns evolved with confirmed candidemia and seven evolved to presumed candidemia. There was no candidemia in non-colonized neonates. The prophylactic use of fluconazole did not decrease mortality in neonates. The prevalence of candidemia in the period was 6.5%. Conclusion: The prophylactic administration of fluconazole to newborns did not show a reduction in mortality, increased the use of liposomal Amphotericin B due to presumed candidemia and did not reduce the incidence of invasive candidemia in the studied population. Histamine blockers, postnatal corticosteroids and broad-spectrum antibiotics have been strongly associated with invasive candidiasis.