Rowen J L, Rench M A, Kozinetz C A, Adams J M, Baker C J
Department of Pediatrics, Baylor College of Medicine, Houston, Texas 77030.
J Pediatr. 1994 May;124(5 Pt 1):789-94. doi: 10.1016/s0022-3476(05)81375-7.
To determine whether growth of Candida from an endotracheal aspirate identifies a population of very low birth weight (VLBW; < or = 1500 gm) neonates at increased risk of systemic candidiasis.
Prospective evaluation with weekly cultures of endotracheal and rectal specimens to determine colonization status.
One hundred sixteen VLBW neonates (mean birth weight, 975 +/- 23 gm, estimated gestational age, 27.6 +/- 0.2 weeks) with endotracheal tubes in place who were admitted to a level III nursery between Jan. 8 and Dec. 2, 1992.
Of the 116 subjects, 39 infants were colonized with Candida (34%). Thirteen neonates had growth of Candida in one or more cultures of endotracheal specimens. Eleven of these could be examined, and in five systemic disease developed (disease in 5/11 vs 2/26; relative risk = 5.9; 95% confidence interval, 1.34 to 26). Eight infants were colonized with Candida in the first week of life. Seven of these could be examined, and in five systemic candidiasis developed (disease in 5/7 vs 2/30; RR = 9.3; 95% confidence interval, 2.3 to 38.0).
Colonization with Candida occurs frequently in VLBW infants. Progression from colonization to systemic infection is more common in the smallest neonates. Detection of colonization in the first week of life or the growth of Candida from an endotracheal aspirate identifies a group of VLBW neonates with an endotracheal tube in place whose risk of systemic candidiasis is increased. A prospective trial of intervention in this high-risk population is warranted.
确定气管内吸出物中念珠菌生长是否可识别出极低出生体重（VLBW；≤1500克）新生儿发生系统性念珠菌病的风险增加。
通过每周对气管内和直肠标本进行培养来确定定植状态的前瞻性评估。
1992年1月8日至12月2日期间入住三级新生儿重症监护病房、已插入气管内导管的116例极低出生体重新生儿（平均出生体重975±23克，估计胎龄27.6±0.2周）。
116例研究对象中，39例婴儿念珠菌定植（34%）。13例新生儿气管内标本的一次或多次培养中有念珠菌生长。其中11例可进行检查，5例发生了系统性疾病（5/11发生疾病，而2/26发生疾病；相对风险=5.9；95%置信区间为1.34至26）。8例婴儿在出生第一周念珠菌定植。其中7例可进行检查，5例发生了系统性念珠菌病（5/7发生疾病，而2/30发生疾病；RR=9.3；95%置信区间为2.3至38.0）。
极低出生体重婴儿念珠菌定植很常见。在最小的新生儿中，从定植进展为系统性感染更为常见。出生第一周检测到定植或气管内吸出物中念珠菌生长可识别出一组已插入气管内导管的极低出生体重新生儿，其发生系统性念珠菌病的风险增加。有必要对这一高危人群进行前瞻性干预试验。
