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1 林 (NICU) 見 率 NICU 6-7% 數 率 率 25% 落 (colonization) 25% (VLBW) 年 genotype 聯 candida enterocytes (microvilli) 連 (junctions) 降 落數 數 28 見 類 ( )Candida (C) C. albicans (C.alb.), C. parapsilosis (C. para.), C. glabrata (C. gla.), c. lusitaneae (C. lusi.) ( )Aspergillus (Asp.) Asp. fumigatus (Asp. fumi.), Asp flavus (Asp. fla) ( ) Mulassezia (M.): M. furfur (M. f.), M. pachydermatis (M.p.) 若 易 C. alb 易 C. para., M.f. M.p.; (TPN) 易 C. M. 流 易 Asp 率 數 0.4~2 VLBW 率 12~15% 罹 率 800 8% % 1001~1500 1% % % % 易罹 3

2 兩 cephalosporins) 留 (central venous catheter) (TPN lipid emulsions) 例 histamine H2 receptor antagonists Apgar score T 數量 5.(neutrophil) 數量 6. 量不 數 cephalosporins 類 降 數 35 若 hydrocortisone candidiasis 度 切 candida C. alb. candidiasis 狀 見 (deeply erythematous skin rash) WBC 5 /mm3 neutrophilia 2~3 x Pneumonitis 索 尿 x x 療 (Nystatin Azoles-Miconazole Clotrimazole) Amphotericin B (Amp-B)/ 1 mg/kg 療 Candida Candida 泌尿 見 例 泌尿 尿 尿 不 Candida candiduria 4

3 renal candidiasis fungal mycelia 50% candiduria 泌尿 fungal mycelia 塞 calyces 泌尿 塞 不 50% 例 療 若 尿 立 尿 泌尿 Azoles ( 例 Fluconazole 4-6 mg/kg/day) 若 泌尿 Amp-B 療 Candida peritonitis 例 見 例 罹 療 Gram stain 切 candida 裂 例 療 療 Amp-B 療 Ampicillin Aminoglycoside 療 enterococi G(-) Clindamycin 療 Amp-B mg/kg/day 7-10 Gram stain Candidemia line infection 1980 年 candida candida late onset sepsis 見 9% 30 Candida 43% 落 臨 狀 不 不 異 數量 heparin 來 不 C. alb. C. para candidemia 例 90% candida C.krusei Azoles 數 益 例 C. alb 率 臨 狀 candida 來 切 立 10% 狀 50% candida 立 立 5

4 療 candidemia 1-3 立 candidemia 率降 3 不 立 6 率 39% 塞 (catheter associated thrombi) Amp-B 1~1.5 mg/kg/day 立 5-Fluocytosine 25 mg/kg/day 療 度 25~50 µg/ml 80% Amp-B creatinine 數 不 療 列 理 Disseminated candidiasis Catheter 流行 (15.2%) (7.7%)(6%) 易 C. alb. 率 C.para., 率 30% 若 C.alb. 不易 7 不 cytokine 不 不 ( ) 1000 罹 易 尿 類 露 糖狀 易 例 69% candida 理切 尿 療 Amp-B 0.7~1.0 mg/kg/ day 若 Fluconazole 療 ( ) lipophilic organism M.f M.p TPN Intrafat 異 狀 例 糖 不 數 立 離 Malassezia 不 若 Amp-B 0.5 mg/kg/day 療 7 ( )Aspergillus 見 度 例 Di George syndrome myeloperoxidase deficiency 6

5 例 osteomyelitis brain abscess Gomori-methenamine silver stain 切 ELISA 不 83% Triazoles 不 療 Aspergillus Amp-B 1-1.5mg/kg/day ( )Trichosporin beigelii 見 Amp-B 率 ( ) 數 28 療 ( ) candida ( ) 不 臨 狀 ( ) Amp-B 療 Amp-B 力 料 量 療 異 Fluconazole 療 Amp-B Amp-B ( ) Fluconazole 度 不 不理 易 coagulase negative staphylococcus 不 Reference: 1. Curr Opin Infect Dis Jun; 17(3): Fungal infection in the very low birthweight infants. Kaufman D. Department of Pediatrics, Division of Neonatology, University of Virginia 2. Eur J Clin Microbiol Infect Dis Oct;23(10): Neonatal candidiasis: analysis of epidemiology, drug susceptibility, and molecular typing of causative isolates. Roilides E, Farmaki E, Evdoridou, J, Dotis J, Hatziioannidis E, Tsivitanidou M, Bibashi E, Filioti I, Sofianou D, Gil- Lamaignere C, Mueller FM, Kremenopoulos G. 3rd Department of Pediatrics, Hippokration Hospital, Aristotle University, Konstantinoupoleos 49, Thessaloniki, Greece, roilides@med.auth.gr 3. J Hosp Infect 2004 Nov; 58(3): Genotyping analysis of colonizing candidal isolates from very-low-birthweight infants in a neonatal intensive care unit. 7

6 Huang YC, Su LH, Wu TL, Lin TY. Division of Paediatric Infectious Diseases, Chang Gung Children s Hospital, Chang Gung University, 5, Fu-Shin Street, Kweishan, Taoyuan, Taiwan. ychuang@adm.cgmh.org.tw 4. Acta Pacdiatr 2004 Jul, 93(7):954-8 The rate of candidaemia in preterm infants born at a gestational age of weeks in inversely correlated to gestational age. Johnsson H, Ewald U. Department of Women s and Children s Health, Uppsala University, Uppsala, Sweden. 5. Drugs. 2004; 64 (9): Antifungals in systemic neonatal candidiasis. Frattarelli DA, Reed MD, Giacoia GP, Aranda JV. Division of Clinical Pharmacology, Children s Hospital of Michigan, Wayne State University School of Medicine, 3901 Beaubien, Detroit, MI 48201, USA. dfattar@med.wayne.edu 6. Cochrane Database Syst Rev. 2004;(1): CD Update of: Cochrane Database Syst Rev. 2003;(1):CD Prophylactic intracenous antifungal agents to prevent mortality and morbidity in very low birth weight infants. McGuire W, Clerthew L, Austin N. Tayside Institute of Child Health, Ninewells Hospital and Medical School, Dundee, UK, DD1 9SY. 7. Cochrane Database Syst Rev. 2004;(1): CD Prophylactic oral antifungal agents to prevent systemic candida infection in presterm infants. Austin NC, Darlow B. Neonatal Intensive Care Unit, Christchurch Woment s Hospital, Christchurch, New Zealand, Private Bag 4711, Christchurch, New Zealand. 8. Cochrane Database Syst Rev, 2004;(1): CD Update of: Cochrane Database Syst Rev. 2000:(2):CD Topical ointment for preventing infection in preterm infants. Conner JM, Soll RF, Edwards WH. Vermont Oxford Network, 33 Kilburn St., Burlington, Vermort 05401; USA 9. Clin Microbiol Rev 2004 Jul;17 (3):638-80, table of contents Clinical microbiology of bacterial and fungal sepsis in very-low-birth-weight infants. Kaufman D, Fairchild KD. Department of Pediatrics Division of Neonatology, P.O.Box , university of Virginia Health System,

7 Old Medical School, Hospital Drive, Charlottesville, VA 29908, USA. 10. Cochrane Database Syst Rev. 2004;(1): CD Systemic antifungal drugs for invasive fungal infection in preterm infants. Clerihew L, McGuire W. Tayside Institute of Child Health, Ninewells Hospital and Mecical School, Dunedee, UK, DDl 9SY. 11. Avery s Diseases of the Newborn, 8 th ed, 2005 pp J Perinat Neonatal Nurs Jul-Sep; 18(3): Strategic us of antibiotices in the neonatal intensive care unit. Tom-Revzone C. Arnold & Marie Schwartz College of Pharmacy and Health Sciences, Long Island University, 75 DeKalb Ave, Brooklyn, NY 11201, USA, catherine.tom@liu.edu 13. Semin Perinatol Oct;27(5): Strategies for prevention of neonatal invasive candidiasis. Kaufman D. Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, VA, USA. davidkaufman@virgina.edu 9