Neonatal invasive candidiasis: A prospective multicenter study of 118 cases
Neonatal invasive candidiasis: A prospective multicenter study of 118 cases
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DOI：
10.1055/s-2003-40008
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发表时间：
2003-04-01
影响因子：
2
通讯作者：
Colomer, BF
中科院分区：
文献类型：
--
作者：
Sastre, JBL;Cotallo, GDC;Colomer, BF
进行了一项前瞻性多中心研究，以评估西班牙新生儿侵袭性念珠菌病的流行病学。在18个月期间，27个参与新生儿单位共收治20，565名新生儿，其中118名（0.57%）新生儿被诊断为系统性念珠菌病。从79名婴儿的血液中分离出念珠菌，从33名婴儿的尿液中分离出念珠菌，从4名婴儿的脑脊液中分离出念珠菌;在2例病例中，尸检时发现深部组织念珠菌病的组织学证据。极低出生体重儿（≤ 1500 g）全身念珠菌病的发病率（4.8%）明显高于体重> 1500 g的婴儿（0.2%）（P < 0.001）。白色念珠菌是最常见的菌种（52.5%），其次是近平滑念珠菌（23.7%）和热带念珠菌（7.6%）。只有7名婴儿接受了阿替霉素B（初始剂量0.18 +/- 0.3 mg/kg，最大日剂量1.7 +/- 0.9 mg/kg）治疗，但其中3名婴儿（43%）因肾毒性而停止治疗。81例新生儿给予脂质体阿替霉素B，29例给予阿替霉素B脂质复合物。在死亡率和不良反应发生率方面，与脂质体阿替霉素B或阿替霉素B脂质复合物治疗没有差异。死亡率为10.2%，所有死亡均发生在伴念珠菌血症的VLBW队列中。
A prospective multicenter study was conducted to assess the epidemiology of neonatal invasive candidiasis in Spain. In a total of 20,565 admissions to the 27 participating neonatal units over an 18-month period, systemic candidiasis was diagnosed in 118 (0.57%) neonates. Candida species were isolated from the blood in 79 infants, from the urine in 33, and from the cerebrospinal fluid in 4; in 2 cases, histologic evidence of deep tissue candidiasis was found at autopsy. Very-low-birth-weight (VLBW) infants (less than or equal to 1500 g) showed a significantly higher incidence of systemic candidiasis (4.8%) than infants weighing > 1500 g (0.2%) (P < 0.001). Candida albicans was the most frequent species (52.5%) followed by C parapsilosis (23.7%), and C tropicalis (7.6%). Only seven infants were treated with amphotericin B (initial dose 0.18 +/- 0.3 mg/kg, maximal daily dose 1.7 +/- 0.9 mg/kg) but treatment was stopped in three of them (43%) due to nephrotoxicity. Liposomal amphotericin B was given to 81 neonates and amphotericin B lipid complex to 29. There were no differences in mortality rate and in the incidence of adverse effects in relation to treatment with liposomal amphotericin B or amphotericin B lipid complex. The mortality rate was 10.2% and all deaths occurred in the VLBW cohort with candidemia.