氟康唑预防极低出生体重儿真菌感染

Fluconazole prophylaxis against fungaus infection in vely low birth weight infants

目的评估氟康唑对极低出生体重儿真菌感染的预防作用。方法2007年3～12月入住我院新生儿重症监护病房的极低出生体重儿139例,随机分为预防组70例及对照组69例。所有患儿入院后根据病情给予对症治疗。预防组患儿于生后第8天起给予氟康唑口服治疗,剂量为6mg·kg-1.d-1,对照组给予奶粉口服。所有入选患儿用药7d后停药,继续观察停药后28d内患儿的各项指标,并定期行直肠真菌培养。结果预防组6/63例真菌培养阳性,对照组15/64例真菌培养阳性(χ2=4.453,P=0.034)。这21例培养阳性病例中,8例在用药后14d内出现,其中2例为预防组,6例为对照组。另13例为第15～28天培养阳性,其中预防组4例,对照组9例。所有21例培养阳性病例中,念珠菌属占16例(白色念珠菌9例,近平滑念珠菌4例,其他类型念珠菌3例),隐球菌3例,曲霉菌2例。结论预防性应用氟康唑能显著地降低真菌在直肠的定植,念珠菌属是最常见的定植菌种。有必要对极低出生体重儿采用高危因素评分法筛选其预防性应用氟康唑对象。

Objective To evaluate prophylactic administration of fluconazole in very low birth weight infants （VLBWI） fungus infection. Methods One hundred and thirty-nine babies were enrolled, 70 were Fluconazole-group and the others were control-group. Each baby received symptomatic treatment. Fluconazole was given to infant from 8th to 14th day. Fungus culture were done weekly the following month. Results Six babies in Fluconazole-group were positive in fungus culture and 15 in control-group （t = 4. 453,P = 0. 034）, 16 of 21 cases were Candida species, 3 were Cryptococcus, and 2 were Aspergillus. Conclusion Prophylactic administration of fluconazole to the VLBW infant results in a reduced the risk of rectal colonization. Candida species is the most common species. It should be build a system to evaluate the fitness for VLBWI in prophylactic administration of fluconazole.