Miranda Lourdes das Neves, Rodrigues Eliete C A, Costa Silvia F, van der Heijden Inneke Marie, Dantas Kátia C, Lobo Renata D, Basso Mariusa, Varkulja Gláucia F, Krebs Vera Lúcia Jornada, Gibelli Maria Augusta Bento Cicaroni, Criado Paulo R, Levin Anna Sara
Department of Infectious Diseases and LIM 54, University of São Paulo, São Paulo, Brazil.
BMJ Open. 2012 Aug 6;2(4). doi: 10.1136/bmjopen-2012-000992. Print 2012.
To evaluate Candida parapsilosis candidaemia in a neonatal unit over 7 years.
Case series study.
A 2000-bed tertiary-care university hospital at São Paulo, Brazil.
Neonates hospitalised in a 63-bed neonatal unit.
We evaluated the incidence of C parapsilosis fungemia in a neonatal unit from 2002 through 2008 and the main microbiological, clinical and epidemiological aspects of this disease in neonates. During the study period an outbreak occurred, an infection control programme was implemented, and isolates from blood and hand healthcare workers (HCWs) were submitted to molecular typing.
During 7 years, there were 36 cases of C parapsilosis fungaemia and annual incidence varied from 0 to 19.7 per 1000 admissions. Evaluating 31 neonates with fungemia, the mean age at diagnosis was 19 days. All children except for one were premature; all had received total parenteral nutrition and all but one had used central venous catheter. Three neonates had received antifungal treatment previously to the diagnosis. Thirty-day mortality was 45%. Only lower birthweight was associated with mortality. C parapsilosis species complex was isolated from hand cultures in eight (11%) of the HCWs (one isolate was identified as C orthopsilosis). By molecular typing no HCW isolate was similar to any of the blood isolates.
The incidence of C parapsilosis fungemia in a neonatal unit varied widely over 7 years. We observed in our series a higher death rate than that reported in European countries and the USA.
评估一家新生儿重症监护病房7年期间近平滑念珠菌血症的情况。
病例系列研究。
巴西圣保罗一家拥有2000张床位的三级大学医院。
入住一家拥有63张床位的新生儿重症监护病房的新生儿。
我们评估了2002年至2008年期间新生儿重症监护病房近平滑念珠菌血症的发病率以及该疾病在新生儿中的主要微生物学、临床和流行病学特征。在研究期间发生了一次暴发，实施了感染控制方案，并对血液和医护人员手部的分离株进行了分子分型。
7年间，共发生36例近平滑念珠菌血症，年发病率为每1000例入院患者0至19.7例。评估31例真菌血症新生儿，诊断时的平均年龄为19天。除1例患儿外，其余均为早产儿；所有患儿均接受了全胃肠外营养，除1例患儿外均使用了中心静脉导管。3例新生儿在诊断前接受过抗真菌治疗。30天死亡率为45%。只有低出生体重与死亡率相关。在8名（11%）医护人员的手部培养物中分离出近平滑念珠菌复合种（1株分离株被鉴定为正平滑念珠菌）。通过分子分型，没有医护人员分离株与任何血液分离株相似。
新生儿重症监护病房近平滑念珠菌血症的发病率在7年间差异很大。我们观察到我们系列中的死亡率高于欧洲国家和美国报道的死亡率。
