Does the use of oral nonabsorbable antifungal prophylaxis reduce the incidence of fungal colonization and/or systemic infection in preterm infants?

Abstract

Invasive fungal infection is a significant cause of mortality and morbidity in preterm infants. Oral nonabsorbable agents are used prophylactically, but the literature regarding their effectiveness has not been systematically reviewed. To determine if oral nonabsorbable antifungal prophylaxis reduces the incidence of fungal colonization and/or systemic infection in preterm infants. The literature was reviewed using the methodology for systematic reviews for the Consensus on Resuscitation Science adapted from the American Heart Association's International Liaison Committee on Resuscitation. Five studies were reviewed. Three level of evidence 1 studies and two level of evidence 3/4 studies provided evidence that the prophylactic use of oral nonabsorbable antifungal agents can reduce the incidence of fungal colonization and/or systemic fungal infection in preterm infants. Prophylactic oral nonabsorbable antifungal medications are an acceptable approach to reduce colonization and invasive fungal infection in preterm infants in units with high baseline colonization rates.