Clinical treatment of Candida albicans deep infection in preterm infants

Abstract

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