Sims M E, Yoo Y, You H, Salminen C, Walther F J
Department of Pediatrics, University of Southern California School of Medicine, Los Angeles.
Am J Perinatol. 1988 Jan;5(1):33-6. doi: 10.1055/s-2007-999649.
Prevention of systemic fungal infection in the very-low-birthweight infant is important since it is associated with a high morbidity and mortality. To determine if oral nystatin administration could prevent fungal colonization and infection, we evaluated 67 preterm infants with birthweights less than 1250 gm. Thirty-three infants received 1 ml (100,000 units/ml) of nystatin inside the mouth every 8 hours until 1 week after extubation. Oropharyngeal, rectal, blood, and urine cultures were obtained on the 1st day of life and weekly. Endotracheal cultures were obtained three times a week from intubated infants. Four (12%) of the 33 nystatin-treated infants had positive cultures, two (6%) developed systemic infection. The control group consisted of 34 infants, 15 (44%) had positive fungal cultures and 11 (32%) developed systemic infection. Fungi isolated were Candida species and Torulopsis glabrata. Colonized infants were dependent on the respirator (P less than 0.001), had indwelling catheters (P less than 0.01), and received antibiotics (P less than 0.05) for a longer period than infants free from fungi and their mortality was significantly higher (P less than 0.05). We conclude that prophylactic administration of oral nystatin reduces fungal colonization and infection in very-low-birthweight infants.
预防极低出生体重儿的系统性真菌感染非常重要，因为其与高发病率和死亡率相关。为了确定口服制霉菌素是否能预防真菌定植和感染，我们评估了67名出生体重小于1250克的早产儿。33名婴儿每8小时口服1毫升（100,000单位/毫升）制霉菌素，直至拔管后1周。在出生第1天及每周采集口咽、直肠、血液和尿液培养物。对插管婴儿每周采集3次气管内培养物。33名接受制霉菌素治疗的婴儿中有4名（12%）培养物呈阳性，2名（6%）发生系统性感染。对照组由34名婴儿组成，15名（44%）真菌培养物呈阳性，11名（32%）发生系统性感染。分离出的真菌为念珠菌属和光滑球拟酵母菌。与未感染真菌的婴儿相比，定植真菌的婴儿使用呼吸机的时间更长（P<0.001），留置导管的时间更长（P<0.01），接受抗生素治疗的时间更长（P<0.05），且死亡率显著更高（P<0.05）。我们得出结论：口服制霉菌素预防性给药可减少极低出生体重儿的真菌定植和感染。
