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Risk Factors for Progression to Invasive Fungal Infection in Preterm Neonates With Fungal Colonization

机译:真菌定植早产儿侵袭性真菌感染进展的危险因素

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OBJECTIVE. Colonization by Candida spp is a major risk factor for development of fungal sepsis, but little is known about the variables associated with progression to invasive disease in already colonized neonates. We investigated such variables in a large number of colonized preterm neonates in an NICU.SETTING. This study was conducted in the Department of Neonatology and the NICU at Sant'Anna Hospital in Torino, Italy.DESIGN AND PATIENTS A database search of clinical charts and weekly surveillance cultures was used to identify all neonates with birth weights 1500 g (very low birth weight) who were admitted to our NICU during 1998–2005 and were colonized (≥1 site) by Candida spp during their stay, as well as infants with invasive fungal infection. The association between a number of factors with progression to invasive fungal infection was evaluated. Those shown to be significantly associated by univariate analysis were cross-checked by logistic regression.RESULTS. Colonization occurred in 201 infants (32.1% of very low birth weight admitted neonates), and invasive fungal infection occurred in 51 (8.1%) of them, with an overall progression rate of 0.25. At univariate analysis, 10 factors (namely low birth weight, low gestational age, use of third-generation cephalosporins, endotracheal intubation, duration of stay in the NICU, bacterial sepsis, colonization of central venous catheter, of endotracheal tube, of gastric aspirate, or in ≥3 [multiple] sites) were associated with an increased risk of progression, whereas prophylaxis with fluconazole was associated to a decreased risk. After logistic regression, only colonization of central venous catheter and colonization in multiple sites remained significantly associated with invasive fungal infection. Fluconazole prophylaxis remained an independent protective factor.CONCLUSIONS. Central venous catheter colonization and multiple-site colonization are independent risk factors and predictors of progression to fungal sepsis in preterm very low birth weight neonates colonized by Candida spp during their stay in the NICU. Fluconazole prophylaxis is an independent protective factor. These findings can be used to improve the surveillance, prophylaxis, or preemptive measures in neonates at high risk.
机译:目的。念珠菌属菌落定殖是真菌性败血症发生的主要危险因素,但对于已经定居的新生儿中与侵袭性疾病进展相关的变量知之甚少。我们在NICU.SETTING中对大量定植的早产儿调查了此类变量。这项研究是在意大利都灵圣安那医院新生儿科和新生儿重症监护病房(NICU)进行的。设计和患者使用临床图表和每周监测培养的数据库搜索来识别出生体重<1500 g(非常低)的所有新生儿。出生体重)在1998年至2005年期间入住我们的新生儿重症监护病房(NICU),并在其逗留期间被念珠菌(Candida spp)以及感染性真菌感染的婴儿定殖(≥1个位点)。评估了多种因素与侵袭性真菌感染进展之间的关联。通过单因素分析显示出显着相关性的那些通过logistic回归进行交叉检验。在201例婴儿中(在极低出生体重的新生儿中占32.1%)发生了定植,其中51例(8.1%)发生了侵袭性真菌感染,总进展率为0.25。在单因素分析中,有10个因素(即低出生体重,低胎龄,使用第三代头孢菌素,气管插管,在NICU的停留时间,细菌性败血症,中心静脉导管定植,气管插管,胃吸出物,或≥3[多个]位点)与进展风险增加相关,而氟康唑的预防与风险降低相关。在逻辑回归后,仅中央静脉导管的定植和在多个部位的定植仍然与侵袭性真菌感染显着相关。氟康唑的预防仍然是一个独立的保护因素。中心静脉导管定植和多部位定植是独立的危险因素,并且是念珠菌属在新生儿重症监护病房期间定植的早产极低出生体重新生儿真菌败血症进展的指标。预防氟康唑是一个独立的保护因素。这些发现可用于改善高危新生儿的监测,预防或先发措施。

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