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A meta-analysis of fluconazole for the prevention of invasive fungal infection in preterm infants.

OBJECTIVE
The present aimed to evaluate the efficacy and safety of fluconazole for prophylactic use in preterm infants with very low birth weight (VLBW) by using an evidence-based methodology.


METHODS
A computerized literature search was conducted in PubMed, the Cochrane Database of Systematic Reviews, MEDLINE, EMBASE, the ISI Web of Knowledge databases, the Chinese Biomedical (CBM) database, China National Knowledge Infrastructure, the WanFang database, and the VIP Chinese science and technology journal database to find all the randomized controlled trials conducted between January 2000 and December 2019 that studied the prevention of invasive fungal infection (IFI) by fluconazole in preterm infants with VLBW. A meta-analysis was conducted using the RevMan 5.3 and GRADEprofiler 3.2.2 software.


RESULTS
A total of 14 studies (including 1,930 preterm infants with VLBW) were included. The meta-analysis found that the prophylactic use of fluconazole significantly reduced the incidence of IFI (RR = 0.39; 95% CI: 0.24-0.64, P < 0.05), overall mortality (RR = 0.77; 95% CI: 0.61-0.97, P < 0.05), and fungal colonization rate (RR = 0.32; 95% CI: 0.25-0.41, P < 0.05) in preterm infants with VLBW. There was no significant effect on some common complications and neurological development in preterm infants. The application of fluconazole would not lead to the development of fungal resistance in the short term and would have no significant adverse effects.


CONCLUSION
The prophylactic use of fluconazole significantly reduced the incidence of IFI, overall mortality, and fungal colonization in preterm infants; however, the impact of prophylactic use of fluconazole on preterm infants needs to be evaluated in a large number of clinical studies because of the limited data.