Fluconazole prophylaxis against invasive candidiasis in very low and extremely low birth weight preterm neonates: a systematic review and meta-analysis.

BACKGROUND: Evidence shows that fluconazole prophylaxis is an effective treatment against invasive fungal infections in preterm neonates, however, the most efficient schedule of fluconazole prophylaxis for the colonization and mortality of invasive candidiasis (IC) is unknown. PURPOSE: This systematic review and meta-analysis aimed to assess the efficiency of different prophylactic fluconazole schedules in controlling IC colonization, infection, and mortality in very low birth weight (VLBW) and extremely low birth weight (ELBW) infants in neonatal intensive care units. METHODS: We searched the PubMed, Scopus, Embase, and Cochrane databases using the keywords "candida," "invasive candidiasis," "IC," "fluconazole prophylaxis," "preterm infants," "very low birth weight infants," "VLBW," "extremely low birth weight," and "ELBW." RESULTS: Mortality was significantly decreased in a metaanalysis of studies using different fluconazole prophylaxis regimens. The meta-analysis also indicated a significant decrease in the incidence of IC-associated mortality in ELBW infants using the same fluconazole prophylaxis schedules. CONCLUSION: Future studies should explore the effectiveness of other different fluconazole prophylaxis schedules on IC colonization, infection, and mortality.

Effectiveness of procalcitonin-guided antibiotic therapy to shorten treatment duration in critically-ill patients with bloodstream infections: a systematic review and meta-analysis.

Evaluation of serum procalcitonin (PCT) levels has been suggested for diagnosis of infection, precise medical decision making and guidance for prescribing antibiotics in critically-ill patients. The aim of this study was to assess the effectiveness of PCT to shorten antibiotic treatment in critically-ill patients with bloodstream infections. Furthermore, the mortality and ICU length of stay (LOS) in such patients were secondary outcomes. Medline/PubMed, EMBASE, Scopus and Cochrane Databases were searched from January 1, 2007 to September 1, 2018. Randomized controlled trials (RCTs) on using PCT to guide antibiotic therapy compared with routine treatments for administration of antibiotics in critically-ill adult patients published in English were included. Two reviewers assessed the methodology of the studies included and extracted their data using the CONSORT checklist. Inverse-variance weighting and fixed and random effects meta-analyses were performed using the length of antibiotic treatment, LOS in an intensive care unit (ICU) and all-cause mortality. No significant reduction was found in the length of antibiotic treatment: although the cut-off point of 0.25