Rowen J L, Tate J M
Department of Pediatrics, University of Texas Medical Branch, Galveston 77555-0371, USA.
Pediatr Infect Dis J. 1998 Nov;17(11):1007-11. doi: 10.1097/00006454-199811000-00008.
To identify areas of consensus and controversy in the management of neonatal candidiasis.
A questionnaire was distributed to US-based members of the Pediatric Infectious Diseases Society and a sampling of US neonatologists.
Three hundred eighty evaluable questionnaires were returned (42% of those mailed). Ninety-five percent of respondents have cared for an infant with systemic candidiasis in the past 2 years. Fluconazole and liposomal amphotericin are used to some extent by 90 and 69% of respondents, respectively. A single blood culture positive for Candida led to a recommendation for immediate treatment by 99%; amphotericin B was the preferred therapy for candidemia (88%). More than 80% of respondents would request cerebrospinal fluid, urine and repeat blood cultures and ophthalmologic examination in the evaluation of candidemia. If a cerebrospinal fluid culture is positive, 25% would use amphotericin B alone whereas 62% would add flucytosine. For candiduria Society members chose fluconazole therapy more often than did neonatologists, 23% vs. 3.4% (P<0.001). There was no consensus concerning duration of therapy, use of an amphotericin B test dose or management of a central catheter in place during candidemia.
Systemic candidiasis in neonates is a frequently encountered clinical problem. There is agreement that prompt therapy with amphotericin B is required if a blood culture is positive for Candida and that such infants require additional evaluations. Other antifungals (fluconazole, liposomal amphotericin B) are used to some extent in this population. Many issues in management have no clear consensus and warrant further research.
确定新生儿念珠菌病管理中的共识和争议领域。
向美国儿科传染病学会成员和部分美国新生儿科医生发放了调查问卷。
共返回380份可评估问卷（占邮寄问卷的42%）。95%的受访者在过去2年中曾护理过患有全身性念珠菌病的婴儿。分别有90%和69%的受访者在一定程度上使用氟康唑和脂质体两性霉素。99%的受访者认为单一血培养念珠菌阳性应立即治疗；两性霉素B是念珠菌血症的首选治疗药物（88%）。超过80%的受访者在评估念珠菌血症时会要求进行脑脊液、尿液和重复血培养以及眼科检查。如果脑脊液培养阳性，25%的受访者会单独使用两性霉素B，而62%的受访者会加用氟胞嘧啶。对于念珠菌尿，学会成员比新生儿科医生更常选择氟康唑治疗，分别为23%和3.4%（P<0.001）。在治疗持续时间、两性霉素B试验剂量的使用或念珠菌血症期间中心静脉导管的管理方面未达成共识。
新生儿全身性念珠菌病是一个常见的临床问题。人们一致认为，如果血培养念珠菌阳性，需要迅速用两性霉素B治疗，且此类婴儿需要进一步评估。其他抗真菌药物（氟康唑、脂质体两性霉素B）在这一人群中也有一定程度的使用。管理中的许多问题尚无明确共识，值得进一步研究。
