Leibovitz Eugene, Livshiz-Riven Ilana, Borer Abraham, Taraboulos-Klein Tali, Zamir Orly, Shany Eilon, Melamed Rimma, Rimon Orna-Flidel, Bradenstein Rita, Chodick Gabriel, Golan Agneta
From the Pediatric Infectious Disease Unit, Soroka University Medical Center.
Scand J Infect Dis. 2013 Nov;45(11):842-8. doi: 10.3109/00365548.2013.814150. Epub 2013 Aug 7.
Knowledge of fungal colonization patterns in very low birth weight infants (VLBWI) admitted to the neonatal intensive care unit (NICU) is essential in understanding the process of fungal infections in neonates. We analyzed prospectively, during 2009-2010, the patterns and dynamics of fungal colonization in VLBWI, including timing, colonization sites, and species involved.
Weekly skin, oropharynx, and rectum/stool surveillance fungal cultures were collected from admission until discharge in VLBWI in the NICU. None received antifungal prophylaxis.
Overall, 118 VLBWI provided 1723 samples; 34 (29%) had 104 positive samples at least once during the first 10 hospitalization weeks. Thirty-nine (33%) weighed < 1000 g; 68 were delivered by cesarean section. Candida albicans (57/104, 55%) and Candida parapsilosis (26/104, 25%) were the main fungi isolated. Eight (24%) VLBWI were colonized during the first week and 23 (68%) during the second week. No differences in colonization were recorded between cesarean section and vaginally delivered VLBWI. The colonization risk at least once during the first 10 weeks was 23% for skin, 14% for oropharynx, 27% for rectum/stool, and 38% for any anatomic site sampled. Persistent colonization was recorded in 5/34 (15%), while transient colonization was found in 14/34 (41%) VLBWI; 16/34 (47%) were discharged or died colonized with Candida spp. Candidemia was diagnosed in 4 (3%) VLBWI and previous/simultaneous colonization was found in 3/4.
The cumulative risk of colonization, at any sampled site and at least once during follow-up, was high. Initial colonization occurred most often during the first 2 weeks of life. Colonization dynamics were characterized by various persistence, disappearance, and recolonization patterns. Candidemia was rare.
了解入住新生儿重症监护病房（NICU）的极低出生体重儿（VLBWI）的真菌定植模式对于理解新生儿真菌感染过程至关重要。我们在2009年至2010年期间对VLBWI的真菌定植模式和动态进行了前瞻性分析，包括定植时间、定植部位和相关菌种。
从入住NICU的VLBWI入院直至出院，每周采集皮肤、口咽和直肠/粪便的监测真菌培养样本。无一例接受抗真菌预防治疗。
总体而言，118例VLBWI提供了1723份样本；34例（29%）在住院的前10周内至少有一次104份阳性样本。39例（33%）体重<1000g；68例通过剖宫产分娩。白色念珠菌（57/104，55%）和近平滑念珠菌（26/104，25%）是分离出的主要真菌。8例（24%）VLBWI在第一周被定植，23例（68%）在第二周被定植。剖宫产和阴道分娩的VLBWI在定植方面无差异。在最初10周内至少有一次的定植风险，皮肤为23%，口咽为14%，直肠/粪便为27%，任何采样解剖部位为38%。5/34例（15%）记录到持续定植，14/34例（41%）VLBWI发现短暂定植；16/34例（47%）出院或死亡时念珠菌属定植。4例（3%）VLBWI诊断为念珠菌血症，3/4例发现先前/同时定植。
在任何采样部位且在随访期间至少有一次的定植累积风险很高。初始定植最常发生在生命的前2周。定植动态的特征是有各种持续、消失和重新定植模式。念珠菌血症罕见。
