Manzoni Paolo, Leonessa Marialisa, Galletto Paolo, Latino Maria Agnese, Arisio Riccardo, Maule Milena, Agriesti Giovanni, Gastaldo Luca, Gallo Elena, Mostert Michael, Farina Daniele
Neonatology and Hospital NICU, Azienda Ospedaliera Regina Margherita-S. Anna C. Spezia 60, 10136 Torino, Italy.
Pediatr Infect Dis J. 2008 Aug;27(8):731-7. doi: 10.1097/INF.0b013e318170bb0c.
We have previously demonstrated efficacy against fungal colonization and infection of fluconazole prophylaxis that was routinely administered since 2001 in our ICU for preterm infants <1500 g at birth (VLBW). With prolonged use, concerns exist for the emergence of acquired fungal resistance and of Candida subspecies that are natively fluconazole-resistant (NFR), mostly Candida glabrata and Candida krusei.
We evaluated retrospectively all clinical and surveillance fungal isolates obtained from VLBW infants in our NICU during a 10-year period (1997-2006). Each fungal isolate was speciated, infants colonized or infected with NFR-Candida spp were identified and the incidence rates of colonization and infection by these fungal species were calculated. A comparison was made of the 6-year (2001-2006) prophylaxis period with the 4-year (1997-2000) preprophylaxis period.
Overall, colonization by NFR-Candida spp ranged between 2.8% and 6.6% of VLBW infants yearly admitted, without any increasing trend during the study period. There were 18 of 434 (4.1%) neonates colonized by these species. Five episodes of systemic fungal infections caused by NFR-Candida spp occurred (incidence rate, 1.1%). No significant differences were detected when compared with the preprophylaxis period, when 11 of 295 infants (3.7%) were colonized by NFR-Candida spp and 4 episodes of infection occurred (1.4%) (P = 0.84 and 0.76, respectively).
Fluconazole prophylaxis administered to VLBW neonates in 4- to 6-week courses after birth does not lead to the emergence of natively fluconazole-resistant Candida spp.
我们之前已经证明，自2001年起在我们的重症监护病房（ICU）对出生时体重<1500克的早产儿（极低出生体重儿，VLBW）常规给予氟康唑预防治疗，对真菌定植和感染有效。随着长期使用，人们担心会出现获得性真菌耐药性以及天然对氟康唑耐药（NFR）的念珠菌亚种，主要是光滑念珠菌和克柔念珠菌。
我们回顾性评估了10年期间（1997 - 2006年）在我们新生儿重症监护病房（NICU）从极低出生体重儿中获得的所有临床和监测真菌分离株。对每个真菌分离株进行菌种鉴定，确定定植或感染NFR念珠菌属的婴儿，并计算这些真菌菌种的定植率和感染率。将6年（2001 - 2006年）的预防治疗期与4年（1997 - 2000年）的预防治疗前期进行比较。
总体而言，每年入院的极低出生体重儿中，NFR念珠菌属的定植率在2.8%至6.6%之间，在研究期间没有任何上升趋势。有434名新生儿中的18名（4.1%）被这些菌种定植。发生了5例由NFR念珠菌属引起的系统性真菌感染（发病率为1.1%）。与预防治疗前期相比，未发现显著差异，在预防治疗前期，295名婴儿中有11名（3.7%）被NFR念珠菌属定植，发生了4例感染（1.4%）（P分别为0.84和0.76）。
出生后对极低出生体重儿给予4至6周疗程的氟康唑预防治疗不会导致天然对氟康唑耐药的念珠菌属出现。
