Huang Y C, Lin T Y, Lien R I, Chou Y H, Kuo C Y, Yang P H, Hsieh W S
Division of Pediatric Infectious Diseases, Chang Gung Children's Hospital, Chang Gung University, Taoyuan, Taiwan.
Am J Perinatol. 2000;17(8):411-5. doi: 10.1055/s-2000-13454.
We reviewed 62 episodes (from 59 infants) of neonatal candidemia that occurred between January 1994 and June 1999. Except 5 term babies, all infants were premature (median gestational age [GA], 30 weeks) and birth weight was less than 2,500 g (median, 1,300 g). Most infants had reported risk factors and other neonatal problems. The age at onset of candidemia ranged from 15 to 173 days with a median of 34 days. In addition to catheter removal, all but one infants received antifungal agents and candidemia was eradicated subsequently in 46 episodes (75%). Eighteen infants with 19 episodes ever received fluconazole therapy. Fluconazole was administered as the first line agent in 6 episodes and successfully cleared candidemia in 5 episodes. Fluconazole was used as an alternative agent in an additional 13 episodes after amphotericin B (am B) +/- flucytosine were given for a period without a satisfactory result and eradication of candidemia was achieved in 8 episodes subsequently. All 18 infants tolerated fluconazole well and no withdrawal was required on account of its adverse effect. In contrast, am B alone was administered as the first line agent in 55 episodes and successfully cleared candidemia in 32 episodes (58%). This retrospective analysis suggests that fluconazole appears to be safe in neonates and can be used as an alternative agent in treating neonatal candidemia. A large-scaled prospective study may be needed.
我们回顾了1994年1月至1999年6月间发生的62例（来自59名婴儿）新生儿念珠菌血症病例。除5名足月儿外，所有婴儿均为早产儿（中位胎龄[GA]，30周），出生体重小于2500克（中位值，1300克）。大多数婴儿有报告的危险因素和其他新生儿问题。念珠菌血症发病年龄为15至173天，中位值为34天。除拔除导管外，除1名婴儿外，所有婴儿均接受了抗真菌药物治疗，随后46例（75%）念珠菌血症得以根除。18名婴儿发生19次念珠菌血症，曾接受氟康唑治疗。氟康唑作为一线药物应用于6例，5例念珠菌血症成功清除。在两性霉素B（am B）+/-氟胞嘧啶治疗一段时间效果不佳后，氟康唑作为替代药物应用于另外13例，随后8例念珠菌血症得以根除。所有18名婴儿对氟康唑耐受性良好，未因不良反应而停药。相比之下，55例中55次将am B单独作为一线药物应用，32例（58%）念珠菌血症成功清除。这项回顾性分析表明，氟康唑在新生儿中似乎是安全的，可作为治疗新生儿念珠菌血症的替代药物。可能需要进行大规模的前瞻性研究。
