Leibovitz E, Iuster-Reicher A, Amitai M, Mogilner B
Department of Pediatrics, Kaplan Hospital, Rehovot, Israel.
Clin Infect Dis. 1992 Feb;14(2):485-91. doi: 10.1093/clinids/14.2.485.
The clinical courses of 25 infants with systemic candidiasis who were treated in the neonatal intensive care unit at Kaplan Hospital, Rehovot, Israel, during the period 1980-1989 were retrospectively analyzed. Twenty-three (92%) weighted less than 1,500 g at birth. Candidemia was associated with prolonged antibiotic therapy, hyperalimentation, and intravenous fat emulsions in all cases and with previous tracheal intubation in 80% of cases. Only one infant had a central venous catheter placed; for all others, hyperalimentation was administered by means of peripheral intravenous catheters. The mean age at onset of systemic candidiasis was 30 +/- 14 days, although an earlier onset (25 +/- 8 days) was noted during the last 3 years of the study period. Candida species were isolated from the blood of 24 infants and from the urine of 10 infants. Microscopic examination of the urine was positive for Candida organisms for three infants and led to a rapid diagnosis. Candidal skin abscesses were present in 11 infants (44%); for two of these infants, the early occurrence of such abscesses prompted the initiation of therapy before confirmation of the diagnosis of systemic candidiasis. All infants were treated with intravenous amphotericin B and oral 5-fluorocytosine. The mortality rate was 20%, but death was directly attributable to candidemia in only three infants (12%).
对1980年至1989年期间在以色列雷霍沃特市卡普兰医院新生儿重症监护病房接受治疗的25例系统性念珠菌病婴儿的临床病程进行了回顾性分析。其中23例（92%）出生时体重不足1500克。所有病例的念珠菌血症均与长期抗生素治疗、胃肠外营养和静脉脂肪乳剂有关，80%的病例与先前的气管插管有关。只有1例婴儿放置了中心静脉导管；其他所有婴儿的胃肠外营养均通过外周静脉导管进行。系统性念珠菌病发病的平均年龄为30±14天，不过在研究期的最后3年中观察到发病更早（25±8天）。从24例婴儿的血液和10例婴儿的尿液中分离出念珠菌属。对3例婴儿的尿液进行显微镜检查发现念珠菌呈阳性，从而实现了快速诊断。11例婴儿（44%）出现念珠菌性皮肤脓肿；其中2例婴儿早期出现此类脓肿，促使在确诊系统性念珠菌病之前就开始治疗。所有婴儿均接受静脉注射两性霉素B和口服5-氟胞嘧啶治疗。死亡率为20%，但只有3例婴儿（12%）的死亡直接归因于念珠菌血症。
