Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Pediatr. 2009 Oct;76(10):1033-44. doi: 10.1007/s12098-009-0219-6. Epub 2009 Nov 12.
Candidemia and disseminated candidiasis are major causes of morbidity and mortality in hospitalized patients especially in the intensive care units (ICU). The incidence of invasive candidasis is on a steady rise because of increasing use of multiple antibiotics and invasive procedures carried out in the ICUs. Worldwide there is a shifting trend from C. albicans towards non albicans species, with an associated increase in mortality and antifungal resistance. In the ICU a predisposed host in one who is on broad spectrum antibiotics, parenteral nutrition, and central venous catheters. There are no pathognomonic signs or symptoms. The clinical clues are: unexplained fever or signs of severe sepsis or septic shock while on antibiotics, multiple, non-tender, nodular erythematous cutaneous lesions. The spectrum of infection with candida species range from superficial candidiasis of the skin and mucosa to more serious life threatening infections. Treatment of candidiasis involves removal of the most likely source of infection and drug therapy to speed up the clearance of infection. Amphotericin B remains the initial drug of first choice in hemodynamically unstable critically ill children in the wake of increasing resistance to azoles. Evaluation of newer antifungal agents and precise role of prophylactic therapy in ICU patients is needed.
念珠菌血症和播散性念珠菌病是住院患者，特别是重症监护病房（ICU）患者发病率和死亡率的主要原因。由于 ICU 中广泛使用多种抗生素和侵入性操作，侵袭性念珠菌病的发病率呈稳步上升趋势。由于非白念珠菌物种的出现以及死亡率和抗真菌药物耐药性的增加，全球范围内念珠菌物种的分布趋势正在发生变化。在 ICU 中，易感宿主是接受广谱抗生素、肠外营养和中心静脉导管治疗的患者。目前还没有特定的症状或体征。临床线索是：在使用抗生素期间出现不明原因的发热或严重败血症或感染性休克的迹象，出现多个、无触痛、结节性红斑性皮肤损伤。念珠菌感染的范围从皮肤和黏膜的浅表性念珠菌病到更严重的危及生命的感染。念珠菌病的治疗包括去除感染的最可能来源和药物治疗以加速感染的清除。在抗真菌药物耐药性不断增加的情况下，两性霉素 B 仍然是血流动力学不稳定的危重症儿童的首选初始药物。需要评估新型抗真菌药物和 ICU 患者预防性治疗的确切作用。
