Department of Pediatrics, Women & Infants Hospital, Providence, RI, USA.
J Pediatr. 2012 Sep;161(3):441-447.e2. doi: 10.1016/j.jpeds.2012.02.051. Epub 2012 Apr 14.
To determine whether premature infants with invasive Candida infection caused by strains with increased virulence properties have worse clinical outcomes than those infected with less virulent strains.
Clinical isolates were studied from 2 populations of premature infants, those colonized with Candida spp (commensal; n = 27) and those with invasive candidiasis (n = 81). Individual isolates of C albicans and C parapsilosis were tested for virulence in 3 assays: phenotypic switching, adhesion, and cytotoxicity. Invasive isolates were considered to have enhanced virulence if detected at a level >1 SD above the mean for the commensal isolates in at least one assay. Outcomes of patients with invasive isolates with enhanced virulence were compared with those with invasive isolates lacking enhanced virulence characteristics.
Enhanced virulence was detected in 61% of invasive isolates of C albicans and 42% of invasive isolates of C parapsilosis. All C albicans cerebrospinal fluid isolates (n = 6) and 90% of urine isolates (n = 10) had enhanced virulence, compared with 48% of blood isolates (n = 40). Infants with more virulent isolates were younger at the time of positive culture and had higher serum creatinine levels.
Individual isolates of Candida species vary in their virulence properties. Strains with higher virulence are associated with certain clinical outcomes.
确定侵袭性念珠菌感染的早产儿，其感染毒力增强的菌株是否比感染毒力较弱菌株的临床结局更差。
从 2 个早产儿群体中研究临床分离株，一组为定植有念珠菌属（共生；n=27），另一组为侵袭性念珠菌病（n=81）。对白色念珠菌和近平滑念珠菌的单个分离株进行 3 种测定，即表型转换、黏附和细胞毒性试验，以检测其毒力。侵袭性分离株如果在至少 1 种测定中，与共生分离株的平均值相比，其水平高于 1 个标准差，则被认为具有增强的毒力。将具有增强毒力的侵袭性分离株的患者的结局与缺乏增强毒力特征的侵袭性分离株的患者的结局进行比较。
61%的白色念珠菌侵袭性分离株和 42%的近平滑念珠菌侵袭性分离株具有增强的毒力。所有白色念珠菌脑脊液分离株（n=6）和 90%的尿液分离株（n=10）均具有增强的毒力，而血液分离株（n=40）中只有 48%具有增强的毒力。具有毒力更强的分离株的婴儿在阳性培养时年龄更小，且血清肌酐水平更高。
白色念珠菌各分离株的毒力特性存在差异。毒力较高的菌株与某些临床结局相关。
