Division of Pediatric Critical Care, University of Alabama at Birmingham, 1600 7th Ave. South, Pediatric Critical Care Office, ACC Ste. 504, Birmingham, AL 35226, USA.
Ann Pharmacother. 2009 Nov;43(11):1907-10. doi: 10.1345/aph.1M350. Epub 2009 Oct 13.
To report the first successful use of anidulafungin and liposomal amphotericin B in an infant with peritoneal candidiasis.
An 11-day-old term female infant with Hirschsprung enterocolitis and bowel perforation was transferred to our institution on day 4 of hospitalization with septic shock and abdominal compartment syndrome. Initial peritoneal culture at time of colectomy did not grow yeast; however, Candida albicans grew from cultures obtained on abdominal washout 2 days later even while the patient was on treatment with liposomal amphotericin B 5 mg/kg/day. Anidulafungin 1.5 mg/kg/day intravenous therapy was instituted, and within 4 days peritoneal cultures were negative. The patient slowly recovered and, after a prolonged hospitalization, she was discharged home on hospital day 68 on partial parenteral nutrition.
Despite the rising incidence of fluconazole-resistant Candida spp., pediatric dosing guidelines, and an adult indication for echinocandin use in candidal peritonitis, there are no reports of echinocandin use for fungal peritonitis in pediatric patients. The echinocandins are rational choices when fluconazole resistance is a concern. Furthermore, the unique clearance profile of anidulafungin makes it an attractive choice in critically ill patients with hepatic and renal dysfunction; the Infectious Diseases Society of America has recommended that an echinocandin be first-line antifungal therapy for moderately or severely ill pediatric or adult patients.
Peritoneal candidiasis is a common complication of bowel perforation in neonates. Anidulafungin's pharmacokinetic and antifungal properties make it a viable therapeutic option in the treatment of this disease in critically ill infants and children.
报告首例婴儿腹腔念珠菌病应用安尼拉fungin 和两性霉素 B 脂质体成功治疗的病例。
一名 11 天大的足月女婴，患有先天性巨结肠合并肠穿孔，在住院第 4 天因感染性休克和腹腔间隔室综合征转入我院。 colectomy 时的初始腹腔培养未生长出酵母；然而，在接受 5mg/kg/天的两性霉素 B 脂质体治疗 2 天后，从腹腔冲洗液中培养出白色念珠菌。开始给予安尼拉fungin 1.5mg/kg/天静脉治疗，4 天后腹腔培养转为阴性。患者逐渐恢复，经过长时间住院，在住院第 68 天开始部分接受肠外营养后出院回家。
尽管氟康唑耐药念珠菌属的发病率不断上升，但儿科剂量指南和成人棘白菌素类药物用于念珠菌性腹膜炎的适应证，儿科患者中尚无棘白菌素类药物用于真菌性腹膜炎的报道。在氟康唑耐药的情况下，棘白菌素类药物是合理的选择。此外，安尼拉fungin 的独特清除特征使其成为肝功能和肾功能不全的危重症患者的理想选择；美国传染病学会建议棘白菌素类药物为中重度儿童或成年患者的一线抗真菌治疗药物。
腹腔念珠菌病是新生儿肠穿孔的常见并发症。安尼拉fungin 的药代动力学和抗真菌特性使其成为治疗危重症婴儿和儿童这种疾病的可行治疗选择。
