Manzoni P, Mostert M, Leonessa M L, Priolo C, Farina D, Monetti C, Latino M A, Gomirato G
Neonatology and Hospital Neonatal Intensive Care Unit, Azienda Ospedaliera Regina Margherita-S. Anna, Turin, Italy.
Clin Infect Dis. 2006 Jun 15;42(12):1735-42. doi: 10.1086/504324. Epub 2006 May 4.
Colonization by Candida species is the most important predictor of the development of invasive fungal disease in preterm neonates, and the enteric reservoir is a major site of colonization. We evaluated the effectiveness of an orally supplemented probiotic (Lactobacillus casei subspecies rhamnosus; Dicoflor [Dicofarm spa]; 6 x 10(9) cfu/day) in the prevention of gastrointestinal colonization by Candida species in preterm, very low birth weight (i.e., < 1500-g) neonates during their stay in a neonatal intensive care unit.
Over a 12-month period, a prospective, randomized, blind, clinical trial that involved 80 preterm neonates with a very low birth weight was conducted in a large tertiary neonatal intensive care unit. During the first 3 days of life, the neonates were randomly assigned to receive either an oral probiotic added to human (maternal or pooled donors') milk (group A) or human milk alone (group B) for 6 weeks or until discharge from the NICU, if the neonate was discharged before 6 weeks. On a weekly basis, specimens obtained from various sites (i.e., oropharyngeal, stool, gastric aspirate, and rectal specimens) were collected from all patients for surveillance culture, to assess the occurrence and intensity of fungal colonization in the gastrointestinal tract.
The incidence of fungal enteric colonization (with colonization defined as at least 1 positive culture result for specimens obtained from at least 1 site) was significantly lower in group A than in group B (23.1% vs. 48.8%; relative risk, 0.315 [95% confidence interval, 0.120-0.826]; P = .01). The numbers of fungal isolates obtained from each neonate (P = .005) and from each colonized patient (P = .005) were also lower in group A than in group B. L. casei subspecies rhamnosus was more effective in the subgroup of neonates with a birth weight of 1001-1500 g. There were no changes in the relative proportions of the different Candida strains. No adverse effects potentially associated with the probiotic were recorded.
Orally administered L. casei subspecies rhamnosus significantly reduces the incidence and the intensity of enteric colonization by Candida species among very low birth weight neonates.
念珠菌属的定植是早产儿侵袭性真菌病发生的最重要预测因素，而肠道是主要的定植部位。我们评估了口服补充益生菌（鼠李糖乳杆菌干酪亚种；迪可弗[迪科法姆制药公司]；6×10⁹ 菌落形成单位/天）对预防极低出生体重（即<1500克）早产儿在新生儿重症监护病房住院期间胃肠道念珠菌属定植的效果。
在12个月的时间里，在一家大型三级新生儿重症监护病房对80例极低出生体重的早产儿进行了一项前瞻性、随机、盲法临床试验。在出生后的前3天，将新生儿随机分为两组，一组接受添加到母乳（母亲或混合捐赠者的母乳）中的口服益生菌（A组），另一组仅接受母乳（B组），为期6周，若新生儿在6周前出院，则至出院。每周从所有患者的不同部位（即口咽、粪便、胃吸出物和直肠标本）采集标本进行监测培养，以评估胃肠道真菌定植的发生情况和强度。
A组真菌肠道定植的发生率（定植定义为从至少1个部位获得的标本至少有1次培养结果为阳性）显著低于B组（23.1%对48.8%；相对危险度，0.315[95%置信区间，0.120 - 0.826]；P = 0.01）。A组从每个新生儿（P = 0.005）和每个定植患者获得的真菌分离株数量也低于B组。鼠李糖乳杆菌干酪亚种在出生体重为1001 - 1500克的新生儿亚组中效果更显著。不同念珠菌菌株的相对比例没有变化。未记录到与益生菌潜在相关的不良反应。
口服鼠李糖乳杆菌干酪亚种可显著降低极低出生体重新生儿肠道念珠菌属定植的发生率和强度。
