Kossoff E H, Buescher E S, Karlowicz M G
Department of Pediatrics, Eastern Virginia Medical School, Children's Hospital of The King's Daughters, Norfolk, USA.
Pediatr Infect Dis J. 1998 Jun;17(6):504-8. doi: 10.1097/00006454-199806000-00014.
To determine changes in the incidence of candidemia in a neonatal intensive care unit (NICU) during a 15-year period (1981 to 1995) and to compare the prevalence and case fatality rates of Candida albicans and Candida parapsilosis infections.
A retrospective study was conducted of candidemia occurring in infants in a NICU between January 1, 1981, and December 31, 1995. Cases were identified through computerized searching of a microbiology blood culture database. Candidemia was considered contributory to mortality if death occurred within 3 days of positive blood cultures or if there was autopsy evidence of disseminated candidiasis.
One hundred eleven cases of candidemia occurred in 107 infants, representing 1% of all NICU patients during the study period. The rate of candidemia in the NICU increased from 2.5 cases per 1000 admissions in 1981 to 1985, to 4.6 per 1000 admissions in 1986 to 1990 and to 28.5 per 1000 in 1991 to 1995 (P = 0.001). C. albicans was the predominant cause of candidemia between 1981 and 1990. C. parapsilosis was the most prevalent species between 1991 and 1995, causing 53 of 89 cases (60%). The mortality from C. albicans, 13 of 50 cases (26%), was significantly higher than the mortality from C. parapsilosis, 2 of 54 (4%) (P = 0.002; relative risk, 7; 95% confidence interval, 1.7 to 30).
The rate of candidemia in our neonatal intensive care unit increased >11-fold in the 15 years from 1981 to 1995; the prevalent Candida species shifted from C. albicans to C. parapsilosis; and candidemia associated with C. albicans has significantly higher mortality than with C. parapsilosis.
确定15年期间（1981年至1995年）新生儿重症监护病房（NICU）念珠菌血症发病率的变化，并比较白色念珠菌和近平滑念珠菌感染的患病率及病死率。
对1981年1月1日至1995年12月31日期间NICU中婴儿发生的念珠菌血症进行回顾性研究。通过对微生物血培养数据库进行计算机检索来确定病例。如果在血培养阳性后3天内死亡，或有尸检证据表明存在播散性念珠菌病，则认为念珠菌血症是导致死亡的原因。
107例婴儿发生了111例念珠菌血症，占研究期间所有NICU患者的1%。NICU中念珠菌血症的发生率从1981年至1985年的每1000例入院2.5例增加到1986年至1990年的每1000例入院4.6例，以及1991年至1995年的每1000例入院28.5例（P = 0.001）。白色念珠菌是1981年至1990年期间念珠菌血症的主要病因。近平滑念珠菌是1991年至1995年期间最常见的菌种，89例中有53例（60%）由其引起。白色念珠菌感染导致的死亡，50例中有13例（26%），显著高于近平滑念珠菌感染导致的死亡，54例中有2例（4%）（P = 0.002；相对危险度，7；95%可信区间，1.7至30）。
从1981年到1995年的15年里，我们新生儿重症监护病房的念珠菌血症发生率增加了11倍以上；常见的念珠菌种从白色念珠菌转变为近平滑念珠菌；与白色念珠菌相关的念珠菌血症的死亡率显著高于与近平滑念珠菌相关的死亡率。
