출생 체중 1kg 미만의 초 극소 저 체중 출생아에서

침습성 진균 감염증에 대한 Fluconazole 예방 요법의 효과 분석

 

임혜민, 양사미†, 박윤희, 한혜원, 곽혜선a, 김재연

서울아산병원 약제팀, 이화여자대학교 약학대학a

 

 

Efficacy of Fluconazole Prophylaxis for Invasive Fungal Infection in 

Extremely Low Birth Weight Infants

 

Hye-min Lim, Sa-mi Yang†, Yun-hee Park, Hye-won Han, Hye-sun Gwaka, and Jae-yeon Kim

Department of Pharmacy, Asan Medical Center, 88 Olympic-ro, 43-Gil, Songpa-gu, Seoul, 138-736, Korea

College of Pharmacy, Ewha Womans University, 52 Ewhayeodae-gil, Seodaemun-gu, Seoul, 120-802, Koreaa

 

 

  Abstract :

  Background :

  An invasive fungal infection (IFI) is an important cause of morbidity and mortality in preterm infants with immature immune systems. In the present study, we evaluated the efficacy in preventing IFI and adverse effects of prophylactic fluconazole in extremely low birth weight infants (ELBWIs).

 

  Methods :

  From January 2010 to July 2012, we conducted a chart review in a total of 106 preterm infants with a birth weight less than 1 kg that were hospitalized in the neonatal intensive care unit (NICU) of the Asan medical center. In May 2011, an unit policy on fluconazole prophylaxis had been implemented (3 mg/kg twice a week intravenous infusion) and we classified the study population into two groups; control group (admitted before the introduction of fluconazole prophylaxis, n=71) and study group (admitted after the introduction of fluconazole prophylaxis, n=35). The incidence of IFI and the strains of infection were investigated and other outcome variables including mortality, morbidity, and adverse effects of fluconazole were also collected.

 

  Results :

  The incidence of IFI was 2.9% in the study group versus 19.7% in the control group (p<0.05). Logistic regression revealed that fluconazole prophylaxis significantly decreased the rates of IFI (Odds ratio 0.082, p<0.05). There was no difference in the incidence of cholestasis between two groups and there was no evidence of hepatotoxicity of fluconazole.

 

  Conclusion :

  The prophylactic administration of fluconazole in ELBWIs revealed its effectiveness in preventing IFI without significant adverse effects.

 

[Key words] Premature infant, Fungal infection, Fluconazole, Prophylaxis