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脂质体两性霉素B治疗羊膜腔内感染并取得成功的新生儿结局。

Intra-amniotic Infection Treated With Liposomal Amphotericin B With a Successful Neonatal Outcome.

作者信息

Gutiérrez Norma Urbano, Vergara López María José, Bustos Camila Álvarez, Vidal Cristian Contreras, Carvajal Jorge A, Severino Nicolás, Giordano Ady, Baquedano Soledad Urzúa, Feuerhake Teo, Rabagliati Ricardo, Balcells María Elvira

机构信息

Departamento de Obstetricia, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.

Programa de Farmacología y Toxicología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.

出版信息

Open Forum Infect Dis. 2024 Jan 31;11(2):ofae047. doi: 10.1093/ofid/ofae047. eCollection 2024 Feb.

DOI:10.1093/ofid/ofae047
PMID:38370293
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10873704/
Abstract

Intra-amniotic infection with species is an uncommon but severe condition with high fetal morbimortality and no established clinical guidelines for its management. We report a intra-amniotic infection diagnosed in a 25-week pregnant woman, successfully treated with high-dose liposomal amphotericin B. Pregnancy was prolonged until 30 weeks, and despite persistently positive cultures in amniotic fluid, a healthy newborn was delivered without evidence of systemic infection. Amphotericin concentration was determined at birth, revealing levels over 30 times higher in mother's and cord blood than in the amniotic fluid, probably explaining the clinical protection despite failure in obtaining fungal clearance.

摘要

羊膜腔内感染 菌种是一种罕见但严重的疾病,胎儿病死亡率高,且尚无既定的临床管理指南。我们报告了一例在一名25周孕妇中诊断出的羊膜腔内感染,经大剂量脂质体两性霉素B成功治疗。妊娠延长至30周,尽管羊水培养持续呈阳性,但仍分娩出一名健康新生儿,无全身感染迹象。出生时测定了两性霉素浓度,结果显示母亲和脐带血中的浓度比羊水中高30倍以上,这可能解释了尽管未能清除真菌但仍有临床保护作用的原因。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/00c1/10873704/152c4a3f44d2/ofae047f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/00c1/10873704/152c4a3f44d2/ofae047f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/00c1/10873704/152c4a3f44d2/ofae047f1.jpg

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Infect Dis Ther. 2021 Mar;10(1):115-147. doi: 10.1007/s40121-020-00382-7. Epub 2021 Feb 1.
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Intra-amniotic infection and sterile intra-amniotic inflammation are associated with elevated concentrations of cervical fluid interleukin-6 in women with spontaneous preterm labor with intact membranes.
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J Matern Fetal Neonatal Med. 2022 Dec;35(25):4861-4869. doi: 10.1080/14767058.2020.1869932. Epub 2021 Jan 7.
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