Candida Enfeksiyonlarında Probiyotik: Tek Merkez Yenidoğan Yoğun Bakım Ünitesinde On Yıllık Tecrübe

Öz

Amaç: Candida türleri, yenidoğan popülasyonunda en önemli morbidite ve mortalite nedenlerinden biridir. Yenidoğanlarda kandida enfeksiyonlarında probiyotik kullanımı tartışmalıdır. Bu çalışmanın amacı yenidoğan yoğun bakım ünitesinde kandida enfeksiyonlarını değerlendirmektir. Metod: YYBÜ'de Candida enfeksiyonu için risk faktörlerini belirlemek için retrospektif tek merkezli, karşılaştırmalı bir vaka kontrol çalışması tasarlanmıştır. Çalışmaya alınan hastaların tümü, çalışma süresi boyunca en az 72 saat YYBÜ'de bulunan yenidoğanlardı. Her vaka için negatif kan kültürü olan 2 kontrol vakası 3 faktör açısından eşleştirildi: gebelik yaşı, doğum ağırlığı, hastanede kalış süresi (1 hafta içinde). Sonuç: 7696 yenidoğan on bir yıl boyunca YYBÜ'de 72 saatten fazla yatırıldı ve 51 vaka (% 0,66) kandida enfeksiyonu ile takip edildi. Kontrol grubunda probiyotik kullanımı daha yüksekti. Cerrahi müdahaleler, santral venöz hatlar ve parenteral beslenme süresi, çoklu antibiyotik kullanımları kandida enfeksiyonları için risk faktörleri olarak bulundu. Sonuç: YYBÜ'de kandida enfeksiyonlarının insidansını azaltmak için çoklu antibiyotiklerin genel kullanımını azaltmanın yanı sıra probiyotik kullanımını artırmaya, kateter bakımını iyileştirmeye etkin bir şekilde odaklanmalıyız. Probiyotiklerin Candida enfeksiyonlarına karşı koruyucu etkisi olabilir.

Anahtar Kelimeler

• yenidoğan
• kandida enfeksiyonu
• risk faktörleri
• probiyotikler

Probiotics in Candida Infections: Ten Years Experience in Single Neonatal Intensive Care Unit

Öz

Objectives: Candida species are one of the most important causes of morbidity and mortality in the neonatal population. The probiotic use is not well documented in candida infections in neonates. The aim of this study was to evaluate candida infections in neonatal intensive care unit. Methods: A retrospective single-center, matched, case-control study was designed to identify individual risk factors for Candida infection in the NICU. Patients enrolled in the analysis were all neonates who were in the NICU during the study period for at least 72 h. For each case, 2 control cases with negative blood culture were matched on 3 factors: gestational age, birth weight, hospitalization time (within 1week compared to case patients). Results: 7696 newborns were admitted to and hospitalized >72 h in the NICU for eleven years and 51 cases (0.66 %) were followed with candida infection. Probiotic usage was higher in control group. Surgical interventions, central venous lines and parenteral nutrition duration, multiple antibiotic usages were found to be risk factors for candida infections. Conclusion: In NICU we should effectively focus on increasing using of probiotics, besides decreasing the overall use of multiple antibiotics, improving catheter care to reduce the incidence of candida infections. Probiotics might have protective effect against candida infections.

Anahtar Kelimeler

• neonate
• candida infection
• risk factors
• probiotics

Kaynakça

1. 1. Lollis TR, Bradshaw WT. Fungal prophylaxis in neonates: a review article. Adv Neonatal Care 2014;14:17-23
2. 2. Manzoni P, Jacqz-Aigrain E, Rizzollo S, Franco C, Stronati M, Mostert M, et al. Antifungal prophylaxis in neonates. Early HumDev 2011; 87(Suppl 1):S59-60.
3. 3. Pammi M, Holland L, Butler G, Gacser A, Bliss JM. Candida parapsilosis is a significant neonatal pathogen: a systematic review and metaanalysis. Pediatr Infect Dis J 2013; 32:e206-216.
4. 4. Arsenault AB, Bliss JM. Neonatal candidiasis: new insights into an old problem at a unique host-pathogen interface. Curr Fungal Infect Rep 2015; 9:246-252.
5. 5. Makhoul IR, Sujov P, Smolkin T, Lusky A, Reichman B. Epidemiological, clinical and microbiological characteristics of late-onset sepsis among very low birth weight infants in Israel: a national survey. Pediatrics 2002;109:34-39
6. 6. Benjamin DK Jr, Stool BJ, Gantz MG, Walsh MC, Sánchez PJ, Das A, et al. Neonatal candidiasis: epidemiology, risk factors, and clinical judgment. Pediatrics 2010; 126: 865-873.
7. 7. Chen J, Jiang Y, Wei B, Ding Y, Xu S, Qin P, et al. Epidemiology of and risk factors for neonatal candidemia at a tertiary care hospital in western China. BMC Infect Dis. 2016 Nov 24;16(1):700.
8. 8. American Academy of Pediatrics. Candidiasis. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th, Kimberlin DW (Ed), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.275.

9. 9. Yu YF, Du LZ, Yuan TM, Zheng JY, Chen A, Chen LH, et al. Risk factors and clinical analysis for invasive fungal infection in neonatal intensive care unit patients. Am J Perinatol 2013; 30:589-594.
10. 10. Moore TA, Wilson ME. Feeding intolerance; a concept analysis. Adv Neonatal Care. 2011; 11:149-154.
11. 11. Alan S, Erdeve Ö. Enteral beslenmede gelişen sorunlar ve yönetimi. In: Prematüre Bebeğin Enteral Beslenmesi (Eds A Bülbül, HS Uslu, A Nuhoğlu):83-98. İstanbul, İstanbul Medikal, 2013.
12. 12. Zaoutis TE, Argon J, Chu J, Berlin JA, Walsh TJ, Feudtner C. The epidemiology and attributable outcomes of candidemia in adults and children hospitalized in the United States: a propensity analysis. Clin Infect Dis 2005; 41: 1232−1239.
13. 13. Stoll BJ, Hansen N, Fanaroff AA, et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics. 2002; 110:285-291.
14. 14. Saiman L, Ludington E, Pfaller M, et al. Risk factors for candidemia in neonatal intensive care unit patients. The National Epidemiology of Mycosis Survey study group. Pediatr Infect Dis J. 2000; 19:319-324.
15. 15. Adams-Chapman I, Bann CM, Das A, Goldberg RN, Stoll BJ, Walsh MC, et al. Neurodevelopmental outcome of extremely low birth weight infants with Candida infection. J Pediatr 2013; 163(4):961−7.e3.
16. 16. Zhang XB, Yu SJ, Yu JX, et al. Retrospective analysis of epidemiology and prognostic factors for candidemia at a hospital in China, 2000–2009. Jpn J Infect Dis. 2012; 65:510–515.
17. 17. Liu M, Huang S, Guo L, Li H, Wang F, Zhang QI, Song G. Clinical features and risk factors for blood stream infections of Candida in neonates. Exp Ther Med. 2015; 10:1139-1144. Epub 2015 Jul 7.
18. 18. Hope WW, Castagnola E, Groll AH, Roilides E, Akova M, Arendrup MC, et al. ESCMID guideline for the diagnosis and management of Candida diseases 2012: prevention and management of invasive infections in neonates and children caused by Candida spp. Clin Microbiol Infect2012;18(Suppl 7):38-52.
19. 19. Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of Candidiasis: 2016 update by the Infectious Diseases Society of America. Clin Infect Dis.2016; 62:e1–50.
20. 20. Manzoni P, Mostert M, Castagnola E. Update on the management of Candida infections in preterm neonates. Arch Dis Child Fetal Neonatal Ed 2015; 100: 454-459.
21. 21. Kelly MS, Benjamin DK Jr, Smith PB. The epidemiology and diagnosis of invasive candidiasis among premature infants. Clin Perinatol. 2015;42:105–117.
22. 22. Fu J, Wang X, Wei B, Jiang Y, Chen Risk factors and clinical analysis of candidemia in very-low-birth-weight neonates. J. Am J Infect Control. 2016; 44:1321-1325.
23. 23. Szajewska H. Probiotics and prebiotics in preterm infants: where are we? Where are we going? Early Hum Dev. 2010; 86; 81-86.
24. 24. Villena J, Salva S, Agu¨ero G, Alvarez S. Immunomodulatory and protective effect of probiotic Lactobacillus casei against Candida albicans infection in malnourished mice. Microbiol Immunol 2011; 55: 434e45.
25. 25. Samonis G, Falagas ME, Lionakis S, Ntaoukakis M, Kofteridis DP, Ntalas I, et al. Saccharomyces boulardii and Candida albicans experimental colonization of the murine gut. Med Mycol 2011; 49:395e9.
26. 26. Kennedy MJ, Volz PA. Ecology of Candida albicans gut colonization: Inhibition of Candida adhesion, colonization, and dissemination from the gastrointestinal tract by bacterial antagonism. Infect Immun 1985; 49: 654-663.
27. 27. Benjamin DK Jr, Stoll BJ, Fanaroff AA, et al. Neonatal candidiasis among extremely low birth weight infants: risk factors, mortality rates, and neurodevelopmental outcomes at 18 to 22 months. Pediatrics. 2006; 117: 84–92.
28. 28. Santolaya ME, Alvarado T, Queiroz-Telles F, et al. Active surveillance of candidemia in children from Latin America: a key requirement for improving disease outcome. Pediatr Infect Dis J. 2014; 33:e40–44.
29. 29. Benjamin DK, Ross K, McKinney Jr RE, et al. When to suspect fungal infection in neonates: a clinical comparison of Candida albicans and Candida parapsilosis fungemia with coagulase negative staphylococcal bacteremia. Pediatrics 2000; 105:712e8.
30. 30. Wu Z, Liu Y, Feng X, Liu Y, Wang S, Zhu X, et al. Candidemia: incidence rates, types of species, and risk factors at a tertiary care academic hospital in China. Int J Infect Dis 2014; 22:4-8.