The Impacts of Fluconazole on Invasive Fungal Infection, Colonization, and Overall Mortality in Preterm Infants: An Updated Systematic Review and Meta-Analysis

Objective: Invasive fungal infection is not uncommon in preterm infants, and fluconazole has been reported to prevent fungal infection. The impacts of fluconazole on invasive fungal infection in preterm infants can be evaluated using an updated systemic review and meta-analysis of randomized clinical trials. Methods: The log risk ratio was transformed using the risk ratio and 95% confidence interval to assess the impacts of fluconazole on fungal infection in preterm infants. After selection, eleven randomized clinical trials of 1097 preterm infants with fluconazole prophylaxis and 953 preterm infants in the control group were enrolled. The focused outcome was the risk ratio and 95% confidence interval of fungal infection in each included study. Results: In the fluconazole prophylaxis group, the significantly lower risk of invasive fungal infection was found in preterm infants. In addition, a similar significantly lower risk of colonization or mortality was found in preterm infants with fluconazole prophylaxis. However, the significantly high heterogeneity was observed in the pooled synthesis of invasive fungal infection. Conclusion: In the updated systematic review and meta-analysis, the preterm infants with fluconazole prophylaxis had a lower risk of invasive fungal infection, colonization, and mortality when compared to the control group. However, the substantial heterogeneity of invasive fungal infection should be considered during the interpretation of our meta-analysis results.