Wu Yejuan, Wei Dong, Gong Xiaohui, Shen Yunlin, Zhu Yingying, Wang Junfang, Gao Zhen
Department of Neonatology, Shanghai Children's Hospital, Shanghai Jiao Tong University, Shanghai, China.
Transl Pediatr. 2020 Aug;9(4):480-486. doi: 10.21037/tp-20-37.
Concerns have arisen regarding the optimal antifungal regimen for () bloodstream infection (BSI) in view of its reduced sensitivity to fluconazole.
The clinical characteristics of 58 BSI newborns who received treatment between June 2014 to December 2018 in the Shanghai Children's Hospital were retrospectively analyzed. Based on the initial antifungal drugs, these patients were divided into fluconazole group (n=30) and voriconazole group (n=21). After 7-10-day treatment, the antifungal drugs were replaced if blood culture still showed positive. The clinical characteristics and therapeutic effects were compared between two groups.
There were no significant differences in the clinical characteristics between two groups (P>0.05). The median time to a negative culture in the voriconazole group was 7 [interquartile range (IQR), 6-10] days, which was significantly shorter than in the fluconazole group [9 (IQR, 7-18.5) days; P=0.034]. The overall median time to a negative culture was 8 days. After 8-day antifungal therapy, in the voriconazole group and fluconazole group, negative culture was observed in 16 and 12 patients, respectively; the positive culture was noted in 5 and 16 patients, respectively; the effective rate was 76.1% and 40%, respectively, showing marked difference (χ=6.535, P=0.011). None died in the voriconazole group, but 4 died in the fluconazole group. The median time of treatment for fungal sepsis in the voriconazole group was 22 (IQR, 20-26) days, which was significantly shorter than in the fluconazole group [32 (IQR, 23.5-40) days; P=0.000].
The initial clinical manifestations of BSI vary among individuals, and voriconazole is superior to fluconazole in the treatment of BSI.
鉴于血流感染（BSI）对氟康唑的敏感性降低，关于其最佳抗真菌治疗方案的担忧已经出现。
回顾性分析2014年6月至2018年12月在上海儿童医院接受治疗的58例BSI新生儿的临床特征。根据初始抗真菌药物，将这些患者分为氟康唑组（n = 30）和伏立康唑组（n = 21）。经过7 - 10天的治疗，如果血培养仍显示阳性，则更换抗真菌药物。比较两组的临床特征和治疗效果。
两组的临床特征无显著差异（P>0.05）。伏立康唑组血培养转阴的中位时间为7天[四分位数间距（IQR），6 - 10天]，显著短于氟康唑组[9天（IQR，7 - 18.5天）；P = 0.034]。血培养转阴的总体中位时间为8天。抗真菌治疗8天后，伏立康唑组和氟康唑组分别有16例和12例血培养转阴；分别有5例和16例血培养阳性；有效率分别为76.1%和40%，差异显著（χ = 6.535，P = 0.011）。伏立康唑组无死亡病例，而氟康唑组有4例死亡。伏立康唑组真菌败血症的中位治疗时间为22天（IQR，20 - 26天），显著短于氟康唑组[32天（IQR，23.5 - 40天）；P = 0.000]。
BSI的初始临床表现因人而异，伏立康唑在治疗BSI方面优于氟康唑。
