Benjamin Daniel K, Poole Charles, Steinbach William J, Rowen Judith L, Walsh Thomas J
Department of Pediatrics, Duke University, Durham, North Carolina, USA.
Pediatrics. 2003 Sep;112(3 Pt 1):634-40. doi: 10.1542/peds.112.3.634.
Neonatal candidemia is an increasing cause of infant morbidity and mortality. We evaluated the current medical literature in an effort to critique the literature and to document the reported prevalences of end-organ damage after neonatal candidemia.
We analyzed all peer-reviewed articles of neonatal candidemia published in the English language; inclusion criteria included a cohort limited to all neonatal intensive care unit admissions or all episodes of candidemia in neonates. Articles that also incorporated older patients, did not define a numerator and a denominator for at least 1 form of end-organ damage, included patients from other reports, or did not include all episodes of candidemia in the source population were excluded from the analysis.
Thirty-four articles reported episodes of candidemia and mortality; 21 articles reported prevalence for at least 1 form of end-organ damage. Only 4 (19%) of 21 articles reported prevalence for >4 forms of end-organ damage from the following list: endophthalmitis, meningitis, brain parenchyma invasion, endocarditis, renal abscesses, positive cultures from other normally sterile body fluids, or hepatosplenic abscesses. The median reported prevalence of endophthalmitis was 3% (interquartile range [IQR]: 0%-17%), of meningitis was 15% (IQR: 3%-23%), of brain abscess or ventriculitis was 4% (IQR: 3%-21%), of endocarditis was 5% (IQR: 0%-13%), of positive renal ultrasound was 5% (IQR: 0%-14%), and of positive urine culture was 61% (IQR: 40%-76%). The medical literature concerning end-organ evaluation after episodes of neonatal candidemia is heterogeneous and consists largely of single-center retrospective studies. Year that the data were collected and prevalence of neonates infected with Candida albicans were associated with observed heterogeneity.
Given the heterogeneity of the medical literature, precise estimates of the frequencies of end-organ damage are not possible and a prospective multicenter trial is warranted, but the data from the published literature suggest that the prevalence of neonates with end-organ damage not only is greater than 0 but also is high enough that until such a prospective trial is completed, end-organ studies should be considered before the conclusion of antifungal therapy.
新生儿念珠菌血症是导致婴儿发病和死亡的一个日益常见的原因。我们评估了当前的医学文献，旨在对文献进行批判性分析，并记录新生儿念珠菌血症后报告的终末器官损害患病率。
我们分析了所有以英文发表的关于新生儿念珠菌血症的同行评审文章；纳入标准包括队列仅限于所有新生儿重症监护病房入院病例或新生儿念珠菌血症的所有发作病例。还纳入了年龄较大患者的文章、未为至少1种终末器官损害形式定义分子和分母的文章、纳入了其他报告中的患者的文章或未包括源人群中所有念珠菌血症发作病例的文章均被排除在分析之外。
34篇文章报告了念珠菌血症发作和死亡率；21篇文章报告了至少1种终末器官损害形式的患病率。在21篇文章中，只有4篇（19%）报告了以下终末器官损害形式中超过4种的患病率：眼内炎、脑膜炎、脑实质侵袭、心内膜炎、肾脓肿、其他通常无菌体液的阳性培养结果或肝脾脓肿。报告的眼内炎患病率中位数为3%（四分位间距[IQR]：0% - 17%），脑膜炎为15%（IQR：3% - 23%），脑脓肿或脑室炎为4%（IQR：3% - 21%），心内膜炎为5%（IQR：0% - 13%），肾脏超声阳性为5%（IQR：0% - 14%），尿培养阳性为61%（IQR：40% - 76%）。关于新生儿念珠菌血症发作后终末器官评估的医学文献存在异质性，且主要由单中心回顾性研究组成。数据收集年份和白色念珠菌感染新生儿的患病率与观察到的异质性相关。
鉴于医学文献的异质性，无法精确估计终末器官损害的频率，因此有必要进行一项前瞻性多中心试验，但已发表文献的数据表明，有终末器官损害的新生儿患病率不仅大于0，而且高到在完成这样一项前瞻性试验之前，在抗真菌治疗结束前应考虑进行终末器官研究。
