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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% 801-1000 3% 1001~1500 1% 1500 0.3% 1500 7% 2500 0.6% 易罹 3

兩 cephalosporins) 留 (central venous catheter) (TPN lipid emulsions) 例 histamine H2 receptor antagonists 1. 1500 2. Apgar score 5 5 3. 4.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

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 0.3-0.5 mg/kg/day 7-10 Gram stain 24-48 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

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 1. 2. 3. 10-14 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

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. 2004 Jun; 17(3):253-9. 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. 2004 Oct;23(10):745-50. 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, 546 42 Thessaloniki, Greece, roilides@med.auth.gr 3. J Hosp Infect 2004 Nov; 58(3):200-3. Genotyping analysis of colonizing candidal isolates from very-low-birthweight infants in a neonatal intensive care unit. 7

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 23-28 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):949-68. 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): CD003850. Update of: Cochrane Database Syst Rev. 2003;(1):CD003850 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): CD003478. 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): CD001150. Update of: Cochrane Database Syst Rev. 2000:(2):CD001150. 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 800386, university of Virginia Health System, 3768 8

Old Medical School, Hospital Drive, Charlottesville, VA 29908, USA. davidkaufman@virginia.edu 10. Cochrane Database Syst Rev. 2004;(1): CD003953. 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. 595-599. 12. J Perinat Neonatal Nurs. 2004 Jul-Sep; 18(3):241-58. 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. 2003 Oct;27(5):414-24 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