Faix R G, Kovarik S M, Shaw T R, Johnson R V
Department of Pediatrics and Communicable Diseases, University of Michigan Medical Center, Ann Arbor 48109-0254.
Pediatrics. 1989 Jan;83(1):101-7.
To determine whether mucocutaneous candidiasis presages the development of invasive candidiasis and to assess factors influencing the development of mucocutaneous candidiasis and invasive candidiasis among infants requiring neonatal intensive care, all infants admitted to our neonatal intensive care unit during a 47-month period were prospectively examined twice weekly for mucocutaneous candidiasis. Because 16 of 18 (89%) infants in whom invasive candidiasis (defined by positive cultures of blood, CSF, deep tissue or greater than or equal to 2 supra-pubic urine aspirates) developed had birth weights less than 1,500 g, further analysis was focused toward the very low birth weight group. Of 358 very low birth weight infants hospitalized for less than three days and serially studied until discharge from the neonatal intensive care unit, mucocutaneous candidiasis developed in 28 (7.8%), invasive candidiasis developed in 16 (4.5%), and in 323 there was no evidence of mucocutaneous candidiasis or invasive candidiasis. Although many risk factors were shown by univariate analysis to be significantly more common among those with invasive candidiasis and mucocutaneous candidiasis, adjustment for the covariant effects of duration of hospitalization and gestational age revealed that only prolonged duration of antibiotic therapy and duration of endotracheal intubation were significantly associated with invasive candidiasis. Invasive candidiasis developed later in nine of 28 (32%) infants with mucocutaneous candidiasis despite nystatin therapy of mucocutaneous candidiasis in all nine (median duration of therapy before invasive candidiasis, nine days). Very low birth weight infants in whom mucocutaneous candidiasis develops are at significantly greater risk of invasive candidiasis developing later than those in whom mucocutaneous candidiasis did not develop (9/28 v 7/330, P less than .001).
为了确定黏膜皮肤念珠菌病是否预示侵袭性念珠菌病的发生，并评估影响新生儿重症监护病房（NICU）中需要重症监护的婴儿发生黏膜皮肤念珠菌病和侵袭性念珠菌病的因素，在47个月期间入住我们NICU的所有婴儿每周接受两次前瞻性检查，以筛查黏膜皮肤念珠菌病。由于18例侵袭性念珠菌病（定义为血液、脑脊液、深部组织培养阳性或耻骨上尿液抽吸物≥2次阳性）婴儿中有16例（89%）出生体重低于1500g，因此进一步分析集中在极低出生体重组。在358例住院时间不足三天并持续研究直至从NICU出院的极低出生体重婴儿中，28例（7.8%）发生了黏膜皮肤念珠菌病，16例（4.5%）发生了侵袭性念珠菌病，323例未出现黏膜皮肤念珠菌病或侵袭性念珠菌病的证据。尽管单因素分析显示许多危险因素在侵袭性念珠菌病和黏膜皮肤念珠菌病患者中明显更常见，但对住院时间和胎龄的协变量影响进行调整后发现，只有抗生素治疗时间延长和气管插管时间与侵袭性念珠菌病显著相关。28例黏膜皮肤念珠菌病婴儿中有9例（32%）在接受制霉菌素治疗黏膜皮肤念珠菌病后（所有9例在侵袭性念珠菌病发生前的治疗中位时间为9天）较晚发生侵袭性念珠菌病。发生黏膜皮肤念珠菌病的极低出生体重婴儿比未发生黏膜皮肤念珠菌病的婴儿发生侵袭性念珠菌病的风险显著更高（9/28对7/330，P<0.001）。
