Hospital for Sick Children, University of Toronto, Ontario.
Department of Paediatrics, London Health Sciences Centre, University of Western Ontario.
Clin Infect Dis. 2017 Apr 1;64(7):921-927. doi: 10.1093/cid/cix001.
Neonatal invasive candidiasis (IC) presenting in the first week of life is less common and less well described than later-onset IC. Risk factors, clinical features, and disease outcomes have not been studied in early-onset disease (EOD, ≤7 days) or compared to late-onset disease (LOD, >7 days).
All extremely low birth weight (ELBW, <1000 g) cases with IC and controls from a multicenter study of neonatal candidiasis enrolled from 2001 to 2003 were included in this study. Factors associated with occurrence and outcome of EOD in ELBW infants were determined.
Forty-five ELBW infants and their 84 matched controls were included. Fourteen (31%) ELBW infants had EOD. Birth weight <750 g, gestation <25 weeks, chorioamnionitis, and vaginal delivery were all strongly associated with EOD. Infection with Candida albicans, disseminated disease, pneumonia, and cardiovascular disease were significantly more common in EOD than in LOD. The EOD case fatality rate (71%) was higher than in LOD (32%) or controls (15%) (P = .0001). The rate of neurodevelopmental impairment and mortality combined was similar in EOD (86%) and LOD (72%), but higher than in controls (32%; P = .007).
ELBW infants with EOD have a very poor prognosis compared to those with LOD. The role of perinatal transmission in EOD is supported by its association with chorioamnionitis, vaginal delivery, and pneumonia. Dissemination and cardiovascular involvement are common, and affected infants often die. Empiric treatment should be considered for ELBW infants delivered vaginally who have pneumonia and whose mothers have chorioamnionitis or an intrauterine foreign body.
早发型新生儿侵袭性念珠菌病（IC）在生命的第一周内比晚发型 IC 更为少见，描述也更少。尚未对早发型疾病（EOD，≤7 天）或与晚发型疾病（LOD，>7 天）进行研究，其危险因素、临床特征和疾病结局也未知。
本研究纳入了 2001 年至 2003 年间一项多中心新生儿念珠菌病研究中患有 IC 的所有极低出生体重（ELBW，<1000g）病例及其 84 例对照。确定了 ELBW 婴儿 EOD 发生和结局的相关因素。
共纳入 45 例 ELBW 婴儿及其 84 例匹配对照。14 例（31%）ELBW 婴儿患有 EOD。出生体重<750g、胎龄<25 周、绒毛膜羊膜炎和阴道分娩均与 EOD 强烈相关。EOD 中更常见的是白色念珠菌感染、播散性疾病、肺炎和心血管疾病。EOD 的病死率（71%）高于 LOD（32%）或对照组（15%）（P=0.0001）。EOD 和 LOD 的神经发育障碍和死亡率合并率相似（EOD 86%，LOD 72%），但高于对照组（32%；P=0.007）。
与 LOD 相比，EOD 的 ELBW 婴儿预后非常差。EOD 与绒毛膜羊膜炎、阴道分娩和肺炎有关，提示围生期传播起作用。播散和心血管受累很常见，受影响的婴儿常死亡。对于阴道分娩、母亲有绒毛膜羊膜炎或宫内异物且患有肺炎的 ELBW 婴儿，应考虑经验性治疗。
