Montagna M T, Lovero G, De Giglio O, Iatta R, Caggiano G, Montagna O, Laforgia N
Department of Biomedical Science and Human Oncology, Hygiene Section, University of Bari Aldo Moro, Italy.
J Prev Med Hyg. 2010 Sep;51(3):125-30.
During the past years invasive fungal infections (IFIs) have become an increasingly important problem in infants hospitalized in the Neonatal Intensive Care Unit (NICU). Candida species is the third most-common agent of late-onset infections in critically ill neonates, with an estimated incidence of 2.6-10% in very low birth weight and 5.5-20% in extremely low birth weight infants. The aim of this observational study is to evaluate the epidemiology of IFIs among infants admitted to NICUs of one Italian region by a multicenter surveillance (Aurora Project).
The IFIs surveillance was carried out prospectively in Apulia (Southern Italy) between February 2007 and August 2008. This report focuses on the results from 6 enrolled NICUs.
Twenty-one neonates developed IFIs: the overall incidence was 1.3% and crude mortality was 23.8%. Infants weighing < or = 1500 g (4.3%) showed a significantly higher incidence than those > or = 2500 g (0.2%). C. parapsilosis (61.9%) was the most frequent isolated species. The main potential risk factors were having a central venous catheter placed, length of stay in NICU > 7 days and total parenteral nutrition for > 5 days. The (1,3)-beta-D glucan (BDG), mannan antigens and anti-Candida antibodies' evaluation was performed in 7 neonates. All neonates were positive to the BDG; the mannan antigen result was positive in 5 newborns, the anti-mannan antibodies were always negative. All isolates were amphotericin B and fluconazole-susceptible.
This first prospective study on neonatal fungal infection in one Italian region gives evidence of a preponderance of non-albicans Candida spp and indicates potential utility of BDG as an adjunct diagnostic test.
在过去几年中，侵袭性真菌感染（IFI）在新生儿重症监护病房（NICU）住院的婴儿中已成为一个日益重要的问题。念珠菌属是危重新生儿晚发性感染的第三大常见病原体，极低出生体重儿的估计发病率为2.6%-10%，超低出生体重儿为5.5%-20%。这项观察性研究的目的是通过多中心监测（奥罗拉项目）评估意大利一个地区NICU收治婴儿中IFI的流行病学情况。
2007年2月至2008年8月在普利亚（意大利南部）对IFI进行了前瞻性监测。本报告重点关注6个参与监测的NICU的结果。
21例新生儿发生IFI：总发病率为1.3%，粗死亡率为23.8%。体重≤1500g的婴儿（4.3%）的发病率显著高于体重≥2500g的婴儿（0.2%）。近平滑念珠菌（61.9%）是最常分离出的菌种。主要潜在危险因素为放置中心静脉导管、在NICU住院时间>7天以及全胃肠外营养>5天。对7例新生儿进行了（1,3）-β-D葡聚糖（BDG）、甘露聚糖抗原和抗念珠菌抗体评估。所有新生儿BDG均呈阳性；5例新生儿甘露聚糖抗原结果为阳性，抗甘露聚糖抗体始终为阴性。所有分离株对两性霉素B和氟康唑敏感。
这项关于意大利一个地区新生儿真菌感染的首次前瞻性研究证明了非白色念珠菌属占优势，并表明BDG作为辅助诊断试验具有潜在效用。
