Early-Onset Invasive Candidiasis in Extremely Low Birth Weight Infants: Perinatal Acquisition Predicts Poor Outcome
Early-Onset Invasive Candidiasis in Extremely Low Birth Weight Infants: Perinatal Acquisition Predicts Poor Outcome
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DOI：
10.1093/cid/cix001
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发表时间：
2017-04-01
影响因子：
11.8
通讯作者：
Richardson, Susan E.
中科院分区：
文献类型：
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作者：
Barton, Michelle;Shen, Alex;Richardson, Susan E.
背景。新生儿侵袭性念珠菌病（IC）在出生后第一周出现的情况比晚发性念珠菌病更少见，对其描述也更少。早发性念珠菌病（EOD， 7天）的危险因素、临床特征和疾病结局尚未进行研究。本研究纳入了2001年至2003年开展的新生儿念珠菌病多中心研究中所有极低出生体重（ELBW, < 1000 g）的IC病例和对照组。研究了与ELBW婴儿发生及预后相关的因素。包括45名ELBW婴儿和84名匹配的对照组。14例（31%）ELBW婴儿有EOD。出生体重< 750 g、妊娠< 25周、绒毛膜羊膜炎和阴道分娩均与EOD密切相关。白色念珠菌感染、播散性疾病、肺炎和心血管疾病在EOD中明显比在LOD中更常见。EOD病死率（71%）高于LOD组（32%）或对照组（15%）（P = 0.0001）。两组神经发育障碍发生率（86%）和死亡率（72%）相似，但高于对照组（32%），P = 0.007。与LOD相比，ELBW合并EOD的婴儿预后非常差。围产期传播在EOD中的作用与绒毛膜羊膜炎、阴道分娩和肺炎有关。传播和心血管受累是常见的，受影响的婴儿经常死亡。对于患有肺炎且母亲患有绒毛膜羊膜炎或宫内异物的经阴道分娩的ELBW婴儿，应考虑经验性治疗。
Background. Neonatal invasive candidiasis (IC) presenting in the first week of life is less common and less well described than later-onset IC. Risk factors, clinical features, and disease outcomes have not been studied in early-onset disease (EOD, 7 days).Methods. All extremely low birth weight ( ELBW, < 1000 g) cases with IC and controls from a multicenter study of neonatal candidiasis enrolled from 2001 to 2003 were included in this study. Factors associated with occurrence and outcome of EOD in ELBW infants were determined.Results. Forty-five ELBW infants and their 84 matched controls were included. Fourteen (31%) ELBW infants had EOD. Birth weight < 750 g, gestation < 25 weeks, chorioamnionitis, and vaginal delivery were all strongly associated with EOD. Infection with Candida albicans, disseminated disease, pneumonia, and cardiovascular disease were significantly more common in EOD than in LOD. The EOD case fatality rate (71%) was higher than in LOD (32%) or controls (15%) (P =.0001). The rate of neurodevelopmental impairment and mortality combined was similar in EOD (86%) and LOD (72%), but higher than in controls (32%; P =.007).Conclusions. ELBW infants with EOD have a very poor prognosis compared to those with LOD. The role of perinatal transmission in EOD is supported by its association with chorioamnionitis, vaginal delivery, and pneumonia. Dissemination and cardiovascular involvement are common, and affected infants often die. Empiric treatment should be considered for ELBW infants delivered vaginally who have pneumonia and whose mothers have chorioamnionitis or an intrauterine foreign body.