Bodin Mary Beth, Godoy Guillermo, Philips Joseph B
University of Alabama School of Nursing, Birmingham, and NICU, DCH Regional Medical Center, Tuscaloosa, Alabama (Dr Bodin); NICU, DCH Regional Medical Center, Tuscaloosa, Alabama, and University of Alabama Departments of Pediatrics and Obstetrics, Tuscaloosa (Dr Godoy); and Department of Pediatrics, Division of Neonatology, University of Alabama at Birmingham (Dr Philips).
Adv Neonatal Care. 2015 Jun;15(3):220-4. doi: 10.1097/ANC.0000000000000170.
Catheter-associated Candida bloodstream infections are a common and serious problem in the neonatal intensive care unit (NICU). Several prophylactic regimens have been developed including oral administration of nonabsorbable antifungals and intravenous infusions. No reports to date have employed a topical regimen.
To evaluate the effectiveness of topical nystatin cream in preventing catheter-associated Candida sepsis.
A retrospective descriptive design was used to determine the incidence of Candida sepsis in extremely low-birth weight (ELBW, <1000 g at birth) infants who were treated with topical nystatin cream for Candida bloodstream infection prophylaxis between January 1, 2000, and December 31, 2010. The electronic medical records of study infants were reviewed to establish the incidence of Candida sepsis.
A total of 464 ELBW infants were admitted to the NICU during the study period. Three infants (0.65%) developed Candida sepsis.
These data demonstrate that a topical nystatin cream protocol is associated with a very low rate of Candida sepsis in ELBW infants with central catheters. The use of this protocol may contribute to a decrease in the morbidity and mortality rate associated with catheter-associated Candida infections in ELBW infants.
Before generalizations can be made as to the safety and efficacy of this protocol as compared to enteral and parenteral prophylactic treatments and in other institutions, large multicenter randomized controlled trials are required.
导管相关念珠菌血流感染是新生儿重症监护病房（NICU）常见且严重的问题。已制定了多种预防方案，包括口服不可吸收抗真菌药和静脉输注。迄今为止，尚无采用局部用药方案的报道。
评估局部用制霉菌素乳膏预防导管相关念珠菌败血症的有效性。
采用回顾性描述性设计，确定2000年1月1日至2010年12月31日期间接受局部用制霉菌素乳膏预防念珠菌血流感染的极低出生体重（ELBW，出生时<1000 g）婴儿中念珠菌败血症的发生率。查阅研究婴儿的电子病历以确定念珠菌败血症的发生率。
研究期间共有464例ELBW婴儿入住NICU。3例婴儿（0.65%）发生念珠菌败血症。
这些数据表明，局部用制霉菌素乳膏方案与中心静脉导管的ELBW婴儿极低的念珠菌败血症发生率相关。采用该方案可能有助于降低ELBW婴儿导管相关念珠菌感染的发病率和死亡率。
在与肠内和肠外预防性治疗及其他机构比较该方案的安全性和有效性并进行推广之前，需要进行大型多中心随机对照试验。
