극소 저체중 출생아에서 전신성 칸디다 감염 : 5년간의 역학적 특성
Systemic Candida Infection in Very Low Birth Weight Infants : Epidemiological Features Over 5 Years
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Purpose : Candida infection has increased in neonatal intensive care units (NICU). However, recent reports on systemic candida infections in preterm newborns are rare in Korea. The aim of this study was to examine the epidemiological features of systemic candida infection in very low birth weight infants (VLBW) over the past five years. Methods : We retrospectively reviewed the medical records of 19 patients with systemic candida infections in VLBW that were admitted to the neonatal intensive care units of three hospitals affiliated with the College of Medicine, The Catholic University of Korea from January 2004 to December 2008. We analyzed the birth weight, gestational age, age at diagnosis, risk factors, co-morbidity, antifungal treatment, and mortality rates among the 19 patients. Results : Systemic candida infections occurred in 19 cases (4.7%) among the VLBW infants. The mean birth weight and gestational age were 959.0±255.9 g and 26.7±2.1 weeks. The isolated Candida species were C. albicans (4), C. parapsilosis (9), C. glabrata (2), C. famata (2), and unkown subspecies (2). Most patients had various associated risk factors, including a central venous catheter, broad spectrum antibiotics, parenteral nutrition, intravenous lipid emulsion, endotracheal intubation and H2 blocker therapy. There was no significant difference in the risk factors between newborns that survived and those that died with regard to the systemic candida infection, except for gestational age. Nine (47.4%) out of 19 patients with a candida infection died and four cases (21.2%) were directly related to the candida infection. Conclusion : The prevalence of systemic candida infection is increasing in VLBW infants. The majority of Candida species has shifted to C. non-albicans, especially C. parapsilosis. Because of the high mortality associated with candida infection in the NICU, prophylaxis and early treatment based on epidemiological features is necessary.
Abstract
Purpose : Candida infection has increased in neonatal intensive care units (NICU). However, recent reports on systemic candida infections in preterm newborns are rare in Korea. The aim of this study was to examine the epidemiological features of systemic candida infection in very low birth weight infants (VLBW) over the past five years. Methods : We retrospectively reviewed the medical records of 19 patients with systemic candida infections in VLBW that were admitted to the neonatal intensive care units of three hospitals affiliated with the College of Medicine, The Catholic University of Korea from January 2004 to December 2008. We analyzed the birth weight, gestational age, age at diagnosis, risk factors, co-morbidity, antifungal treatment, and mortality rates among the 19 patients. Results : Systemic candida infections occurred in 19 cases (4.7%) among the VLBW infants. The mean birth weight and gestational age were 959.0±255.9 g and 26.7±2.1 weeks. The isolated Candida species were C. albicans (4), C. parapsilosis (9), C. glabrata (2), C. famata (2), and unkown subspecies (2). Most patients had various associated risk factors, including a central venous catheter, broad spectrum antibiotics, parenteral nutrition, intravenous lipid emulsion, endotracheal intubation and H2 blocker therapy. There was no significant difference in the risk factors between newborns that survived and those that died with regard to the systemic candida infection, except for gestational age. Nine (47.4%) out of 19 patients with a candida infection died and four cases (21.2%) were directly related to the candida infection. Conclusion : The prevalence of systemic candida infection is increasing in VLBW infants. The majority of Candida species has shifted to C. non-albicans, especially C. parapsilosis. Because of the high mortality associated with candida infection in the NICU, prophylaxis and early treatment based on epidemiological features is necessary.
참고문헌 (17)
- Stoll BJ, "Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network", Pediatrics, 110, pp.285~291 (2002)
- Butler KM, "Candida: an increasingly important pathogen in the nursery", Pediatr Clin North Am, 35, pp.543~563 (1988)
- Friedman S, "Systemic Candida infection in extremely low birth weight infants: short term morbidity and long term neurodevelopmental outcome", Pediatr Infect Dis J, 19, pp.499~505 (2000)
- Levy I, "Emergence of Candida parapsilosis as the predominant species causing candidemia in children", Clin Infect Dis, 26, pp.1086~1088 (1998)
- Kossoff EH, "Candidemia in a neonatal intensive care unit: trends during fifteen years and clinical features of 111 cases", Pediatr Infect Dis J, 17, pp.504~508 (1998)
- Critchley IA, "Differential adhesion of pathogenic Candida species to epithelial and inert surfaces", FEMS Microbiol Lett, 28, pp.199~203 (1985)
- Kaufman D, "Fungal infection in the very low birth weight infant", Curr Opin Infect Dis, 17, pp.253~259 (2004)
- Saiman L, "Risk factors for candidemia in neonatal intensive care unit patients", Pediatr Infect Dis J, 19, pp.319~324 (2000)
- Kim DH, "Systemic candidiasis in neonatal intensive care unit: a 8-year experience", J Korean Soc Neonatal, 8, pp.33~45 (2001)
- 최익선, "신생아 중환자실에서 캔디다 패혈증의 발생 추이와 위험 인자", Korean Journal of Pediatrics, 45(7), pp.4~846 (2002), 대한소아과학회
- 김수영, "고위험 극소저체중 출생아에서 fluconazole 예방요법", Korean Journal of Pediatrics, 50(7), pp.636~642 (2007), 대한소아과학회
- Vendettuoli V, "The role of Candida surveillance cultures for identification of a preterm subpopulation at highest risk for invasive fungal infection", Pediatr Infect Dis J, 27, pp.1114~1116 (2008)
- Kaufman D, "Strategies for prevention of neonatal invasive candidiasis", Semin Perinatol, 27, pp.414~424 (2003)
- Kaufman D, "Fluconazole prophylaxis against fungal colonization and infection in preterm infants", N Engl J Med, 345, pp.1660~1666 (2001)
- Manzoni P, "A multicenter, randomized trial of prophylactic fluconazole in preterm neonates", N Engl J Med, 356, pp.2483~2495 (2007)
- Abi-Said D, "The epidemiology of hematogenous candidiasis caused by different Candida species", Clin Infect Dis, 24, pp.1122~1128 (1997)
- Sarvikivi E, "Emergence of fluconazole resistance in a Candida parapsilosis strain that caused infections in a neonatal intensive care unit", J Clin Microbiol, 43, pp.2729~2735 (2005)