Sriram Bhavani, Agarwal Pratibha K, Tee Nancy W S, Rajadurai Victor S
Department of Neonatology, KK Women's and Children's Hospital, Singapore.
Ann Acad Med Singap. 2014 May;43(5):255-62.
This study aims to determine the incidence, trends of systemic candidiasis and meningitis in extremely low birthweight (ELBW) neonates (<1000 gms) despite the routine use of topical miconazole prophylaxis and to compare the risk factors, adverse outcomes and comorbidities with controls.
Retrospective cohort study of ELBW neonates with systemic candidiasis and meningitis over an 11-year period (1997 to 2007). Matched case control analyses were performed to determine the risk factors and comorbidities which were severe intraventricular haemorrhage (IVH), severe retinopathy of prematurity (ROP), patent ductus arteriosus (PDA) requiring treatment, necrotising enterocolitis (NEC), chronic lung disease (CLD) and cholestatic jaundice. Mortality and end organ involvement secondary to systemic candidiasis were identified as adverse outcomes.
Of the 757 ELBW neonates, 51 (6.7%) had evidence of systemic candidiasis with a significant 3-fold increase in trend noted in 2007 as compared against 1997 (12.1% vs 3.8%) (RR 1.2, 95% CI, 1.06 to 1.36, P <0.001). This corresponds to a significant increasing trend of preceding or co-existent bacterial blood stream infections (BSI) in neonates with systemic candidiasis (0% in 1997 vs 7.1% in 2007, RR 1.40, 95% CI, 1.04 to 1.25, P = 0.005). On logistic regression analysis, decreasing gestational age was an independent risk factor for systemic candidiasis (OR 2.0, 95% CI, 1.52 to 2.63, P <0.001). Candida meningitis was detected in 4/38 (10.5%) and end organ involvement in 17 (33%). The organisms isolated were Candida parapsilosis 31 (61%), Candida albicans 17 (33%) and Candida glabrata 3 (5.8%). Significantly higher mortality was seen in cases when compared to controls 10/51 (19.6%) vs 76/706 (10.7%) (OR 2.02, 95% CI, 1.02 to 4.40, P <0.001).
Increasing trend in the incidence of systemic candidiasis despite routine use of topical miconazole prophylaxis is of concern and future studies comparing the use of systemic fl uconazole versus oral nystatin may need to be considered.
本研究旨在确定极低出生体重（ELBW，<1000克）新生儿中系统性念珠菌病和脑膜炎的发病率、趋势，尽管已常规使用局部咪康唑进行预防，并将其危险因素、不良结局和合并症与对照组进行比较。
对11年期间（1997年至2007年）患有系统性念珠菌病和脑膜炎的ELBW新生儿进行回顾性队列研究。进行配对病例对照分析以确定危险因素和合并症，包括严重脑室内出血（IVH）、严重早产儿视网膜病变（ROP）、需要治疗的动脉导管未闭（PDA）、坏死性小肠结肠炎（NEC）、慢性肺病（CLD）和胆汁淤积性黄疸。将系统性念珠菌病继发的死亡率和终末器官受累确定为不良结局。
在757例ELBW新生儿中，51例（6.7%）有系统性念珠菌病的证据，与1997年相比，2007年趋势显著增加了3倍（12.1%对3.8%）（相对危险度1.2，95%可信区间，1.06至1.36，P<0.001）。这对应于系统性念珠菌病新生儿中先前或并存的细菌性血流感染（BSI）的显著增加趋势（1997年为0%，2007年为7.1%，相对危险度1.40，95%可信区间，1.04至1.25，P = 0.005）。逻辑回归分析显示，胎龄降低是系统性念珠菌病的独立危险因素（比值比2.0，95%可信区间，1.52至2.63，P<0.001）。在38例中有4例（10.5%）检测到念珠菌性脑膜炎，17例（33%）有终末器官受累。分离出的病原体为近平滑念珠菌31例（61%）、白色念珠菌17例（33%）和光滑念珠菌3例（5.8%）。与对照组相比，病例组的死亡率显著更高，分别为10/51（19.6%）对76/706（10.7%）（比值比2.02，95%可信区间，1.02至4.40，P<0.001）。
尽管常规使用局部咪康唑进行预防，但系统性念珠菌病的发病率仍呈上升趋势，这令人担忧，未来可能需要考虑比较全身性氟康唑与口服制霉菌素使用情况的研究。
