Dean J L, Wolf J E, Ranzini A C, Laughlin M A
Department of Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
Clin Infect Dis. 1994 Mar;18(3):364-8. doi: 10.1093/clinids/18.3.364.
Unlike the situation with many antimicrobial agents, there is limited experience with the use of amphotericin B during pregnancy. Although reports of fungal infections during pregnancy have been published, few describe fungemia with either Candida or Torulopsis species. We present a case of fungemia due to Torulopsis glabrata that occurred during pregnancy and that was treated with amphotericin B. Drug concentrations were measured in placental tissue, cord serum, and infant serum at delivery. Although the last dose of amphotericin B was administered 4 weeks before delivery, the concentrations in all three specimens were still within the MIC ranges for most strains of Candida albicans and T. glabrata as measured by broth dilution. We speculate that persistent tissue concentrations of amphotericin B most likely contributed to the sustained hypokalemia in the mother and the increased creatinine level in the infant. In the latter case, placental tissue may have served as the reservoir from which amphotericin B was slowly released into fetal circulation.
与许多抗菌药物的情况不同，两性霉素B在孕期使用的经验有限。尽管已有关于孕期真菌感染的报道，但很少有描述念珠菌或球拟酵母菌属引起的真菌血症。我们报告一例孕期发生的光滑球拟酵母菌真菌血症，患者接受了两性霉素B治疗。分娩时测定了胎盘组织、脐带血清和婴儿血清中的药物浓度。尽管最后一剂两性霉素B在分娩前4周给药，但通过肉汤稀释法测定，所有三个标本中的浓度仍在大多数白色念珠菌和光滑球拟酵母菌菌株的最低抑菌浓度范围内。我们推测，两性霉素B在组织中的持续浓度很可能是导致母亲持续低钾血症和婴儿肌酐水平升高的原因。在后一种情况下，胎盘组织可能充当了两性霉素B缓慢释放到胎儿循环中的储存库。
