Burwell Lauren A, Kaufman David, Blakely Jennifer, Stoll Barbara J, Fridkin Scott K
Office of Workforce and Career Development, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Pediatrics. 2006 Oct;118(4):e1019-26. doi: 10.1542/peds.2006-0446. Epub 2006 Sep 18.
Bloodstream infections with Candida species have a high mortality rate in very low birth weight infants. Preliminary data suggest that prophylaxis with fluconazole reduces the incidence of colonization and invasive Candida infections in high-risk, very low birth weight neonates. The extent of antifungal prophylaxis use to prevent neonatal candidemia is unknown.
We surveyed a 20% random sample of the members of the American Academy of Pediatrics Section on Perinatal Pediatrics. We collected information on prophylactic agents used, indications for use, and rationale for reported practices.
A total of 219 (47%) of 469 members sampled responded; 3 clinicians who did not provide care to very low birth weight infants were excluded. Antifungal prophylaxis use was reported by 73 (34%) respondents. Agents used included intravenous fluconazole (66%), oral nystatin (59%), and intravenous amphotericin B (21%). Decreased birth weight or early gestational age was the most frequent indication to start prophylaxis (57 [78%]). Respondents who did not use antifungal prophylaxis compared with respondents who used fluconazole prophylaxis were significantly more likely to have concerns about (1) the emergence of antifungal resistance, (2) unclear criteria on which to base the decision to start prophylaxis, and (3) the need for clarification of the role of surveillance cultures.
Although preliminary data suggest that fluconazole is efficacious to prevent candidemia in a subset of neonates, this practice is not used widely by clinicians who care for very low birth weight infants. Additional efficacy studies should address the emergence of antifungal resistance or clarification of criteria to initiate prophylaxis, including the role of surveillance cultures.
念珠菌属血流感染在极低出生体重儿中死亡率很高。初步数据表明，氟康唑预防可降低高危极低出生体重新生儿的定植和侵袭性念珠菌感染发生率。用于预防新生儿念珠菌血症的抗真菌预防措施的使用范围尚不清楚。
我们对美国儿科学会围产期儿科学分会20%的成员进行了随机抽样调查。我们收集了有关使用的预防药物、使用指征及报告做法的理由等信息。
469名抽样成员中共有219名（47%）做出回应；排除3名不负责极低出生体重儿护理的临床医生。73名（34%）受访者报告使用了抗真菌预防措施。使用的药物包括静脉用氟康唑（66%）、口服制霉菌素（59%）和静脉用两性霉素B（21%）。出生体重降低或孕周早是开始预防的最常见指征（57名[78%]）。与使用氟康唑预防的受访者相比，未使用抗真菌预防措施的受访者更有可能担心：（1） 抗真菌耐药性的出现；（2） 开始预防的决策依据不明确；（3） 需要澄清监测培养的作用。
尽管初步数据表明氟康唑对预防部分新生儿念珠菌血症有效，但照顾极低出生体重儿的临床医生并未广泛采用这种做法。更多疗效研究应关注抗真菌耐药性的出现或预防起始标准的明确，包括监测培养发挥的作用。
