Department of Public Health, China Medical University, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan; Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan.
Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan.
J Microbiol Immunol Infect. 2013 Dec;46(6):456-62. doi: 10.1016/j.jmii.2012.07.013. Epub 2012 Oct 8.
Fungemia in preterm infants is associated with high mortality and morbidity. This study reports an outbreak of unusual fungemia in a tertiary neonatal intensive care unit (NICU).
Ten Candida pelliculosa bloodstream isolates were identified from six infants hospitalized in the NICU from February to March 2009. Environmental study was performed, and genetic relatedness among the 10 clinical isolates of C pelliculosa and six control C pelliculosa strains was characterized by randomly amplified polymorphic DNA assay. In vitro susceptibility of isolates to six antifungal agents was analyzed by broth microdilution method. Amphotericin B was given to infected infants and prophylactic fluconazole was prescribed to the other noninfected extremely low birth weight infants during the outbreak.
Thrombocytopenia (platelet counts <100×10(9)/L) was the early laboratory finding in four infants. One of six patients died, making overall mortality 17%. Fluconazole, voriconazole, amphotericin B, and micafungin provided good antifungal activity. Cultures from the environment and hands of caregivers were all negative. Molecular studies indicated the outbreak as caused by a single strain. The outbreak was controlled by strict hand washing, cohort infected patients, confined physicians and nurses to take care of patients, prophylactic fluconazole to uninfected neonates, and proper management of human milk.
The study demonstrated the clinical importance of emerged non-albicans Candida species in NICU. For unusual pathogen isolated from immunocompromised hosts, more attention should be paid to monitor the possibility of an outbreak.
早产儿菌血症与高死亡率和发病率有关。本研究报告了一家三级新生儿重症监护病房（NICU）中不寻常菌血症的爆发。
从 2009 年 2 月至 3 月在 NICU 住院的六名婴儿中鉴定出 10 株假丝酵母包膜菌血流感染。进行了环境研究，并通过随机扩增多态性 DNA 分析鉴定了 10 株临床分离的假丝酵母包膜菌和 6 株对照假丝酵母包膜菌的遗传相关性。通过肉汤微量稀释法分析了分离株对六种抗真菌药物的体外敏感性。在爆发期间，给感染的婴儿使用两性霉素 B，并给其他未感染的极低出生体重婴儿预防性使用氟康唑。
四名婴儿中有四名出现血小板减少症（血小板计数 <100×10(9)/L）的早期实验室发现。六名患者中有一名死亡，总死亡率为 17%。氟康唑、伏立康唑、两性霉素 B 和米卡芬净具有良好的抗真菌活性。环境和护理人员手部的培养物均为阴性。分子研究表明，这是由单一菌株引起的爆发。通过严格洗手、对感染患者进行分组、限制医生和护士照顾患者、对未感染的新生儿进行预防性氟康唑治疗以及对人乳进行适当管理，控制了疫情的爆发。
本研究表明，非白念珠菌假丝酵母在 NICU 中的临床重要性。对于免疫功能低下宿主中分离出的不寻常病原体，应更加注意监测爆发的可能性。
