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中华妇幼临床医学杂志(电子版) ›› 2017, Vol. 13 ›› Issue (04) : 397 -402. doi: 10.3877/cma.j.issn.1673-5250.2017.04.005

所属专题： 文献；

论著

早产儿白色念珠菌深部感染的临床治疗
李晋辉1, 王华1,†(), 唐军1, 伍金林1, 宁刚2   
  1. 1. 610041　成都，四川大学华西第二医院新生儿科、出生缺陷与相关妇儿疾病教育部重点实验室
    2. 610041　成都，四川大学华西第二医院放射科
  • 收稿日期:2017-02-01 修回日期:2017-04-20 出版日期:2017-08-01
  • 通信作者: 王华

Clinical treatment of Candida albicans deep infection in preterm infants

Jinhui Li1, Hua Wang1,†(), Jun Tang1, Jinlin Wu1, Gang Ning2   

  1. 1. Department of Neonatology, Key Laboratory of Birth Defects and Related Disease of Women and Children (Sichuan University), Ministry of Education
    2. Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
  • Received:2017-02-01 Revised:2017-04-20 Published:2017-08-01
  • Corresponding author: Hua Wang
  • About author:
    Corresponding author: Wang Hua, Email:
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引用本文：

李晋辉, 王华, 唐军, 伍金林, 宁刚. 早产儿白色念珠菌深部感染的临床治疗[J]. 中华妇幼临床医学杂志(电子版), 2017, 13(04): 397-402.

Jinhui Li, Hua Wang, Jun Tang, Jinlin Wu, Gang Ning. Clinical treatment of Candida albicans deep infection in preterm infants[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2017, 13(04): 397-402.

目的

探讨氟康唑、两性霉素B脂质体联合氟胞嘧啶治疗早产儿白色念珠菌深部感染及中枢神经系统感染的安全性。

方法

选择2014年8月及2016年4月，于四川大学华西第二医院新生儿重症监护病房(NICU)收治的3例白色念珠菌深部感染及中枢神经系统感染患儿(患儿1：女性，生后24 min；患儿2：女性，生后18 min；患儿3：男性，生后42 min)的临床病例资料为研究对象。本研究根据药敏试验结果，对氟康唑耐药的患儿1与患儿2，采用氟康唑、两性霉素B脂质体联合氟胞嘧啶治疗，总疗程为6～8周；对氟康唑敏感的患儿3，单用氟康唑治疗。采用回顾性分析方法，对治疗过程中，3例患儿的临床症状、体征及相关血清学、脑脊液与影像学检查指标，以及预后情况进行分析。

结果

本组3例白色念珠菌深部感染患儿均为早产儿。经治疗后，3例患儿的临床症状均显著改善。治疗过程中，3例患儿均未发生严重药物不良反应，血培养结果显示真菌培养试验均呈阴性。这3例患儿中，患儿1并发脑积水，对其进行脑室腹腔分流术后治愈。

结论

两性霉素B脂质体联合氟胞嘧啶，对于治疗氟康唑耐药的早产儿白色念珠菌深部感染有效，而且相对安全。对存在白色念珠菌深部感染高危因素的早产儿，应该合理预防二重感染的发生。

关键词: 中枢神经系统真菌感染, 感染，真菌性, 念珠菌，白色, 两性霉素B脂质体, 氟胞嘧啶, 氟康唑, 婴儿，早产
Objective

To investigate the efficacy and safety of liposomal amphotericin B combined with 5-fluorocytosine in the treatment of Candida albicans deep infection and central nervous system infection in preterm infants.

Methods

Clinical data of three cases of Candida albicans deep infection and central nervous system infection (case 1: female, 24 min after birth; case 2: female, 18 min after birth; case 3: male, 42 min after birth) who were treated in neonatal intensive care unit (NICU) of West China Second University Hospital, Sichuan University in August 2014 and April 2015 was collected as research subjects. According to the drug susceptibility test results, case 1 and case 2 who were resistant to fluconazole were treated with fluconazole and liposomal amphotericin B combined with 5-fluorocytosine with total period of 6-8 weeks. And case 3 who was sensitive to fluconazole was only treated with fluconazole. Retrospective analysis method was used to analyze the clinical symptoms and signs, serological and cerebrospinal fluid changes and neuroimaging changes, and prognosis of the three cases.

Results

All the three cases of Candida albicans deep infection were premature infants. The clinical symptoms were significantly improved in all three cases after treatment. And no serious adverse drug reactions occured during treatment and blood cultures results showed that fungal culture tests were negative after treatment. Case 1 who was combined with hydrocephalus received ventriculo-peritoneal shunt and was cured.

Conclusions

It is effective and relatively safe for the treatment of fluconazole-resistant Candida albicans deep infection with liposomal amphotericin B combined with 5-fluorocytosine in preterm infants. Superinfection should be reasonably prevented in preterm infants with high risk of Candida albicans deep infection.

Key words: Central nervous system fungal infections, Infections, fungal, Candida albicans, Liposomal amphotericin B, Fluorocytosine, Fluconazole, Infant, premature
图1 患儿1(女性，生后24 min)影像学检查结果(图1A：头颅CT检查结果；图1B、1C：头颅MRI检查结果)
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