RESUMEN
We studied the prevalence of Malassezia furfur skin colonization of infants hospitalized in our neonatal and infant cardiac and surgical intensive care units by culturing at monthly intervals. Of 361 infants studied over 1 year, 133 (36.8%) had at least one positive culture for M. furfur. Colonized infants, compared with noncolonized infants, had younger mean gestational age (32.4 vs 35.2 weeks, P less than 0.01), lower mean birth weight (1.76 vs 2.31 kg, P less than 0.01), a longer stay in hospital (Wilcoxon P less than 0.01), and more mean days use of an incubator (12.7 vs 7.6 days, P less than 0.01), lamb wool (12.9 vs 8.2 days, P less than 0.01), paper tape (10.8 vs 8.2 days, P less than 0.01), and Op-Site tape (14.1 vs 10.1 days, P less than 0.01). These data suggest that hospitalization in an infant intensive care unit often leads to M. furfur colonization. Although frequent adult handling may be a source, other aspects of intensive care will require careful scrutiny to define more completely the risk factors leading to M. furfur colonization of ill infants.
Asunto(s)
Unidades de Cuidado Intensivo Neonatal , Malassezia/aislamiento & purificación , Piel/microbiología , Peso al Nacer , Infección Hospitalaria/epidemiología , Infección Hospitalaria/etiología , Dermatomicosis/epidemiología , Dermatomicosis/etiología , Edad Gestacional , Humanos , Recién Nacido , Tiempo de Internación , Ohio , Riesgo , Factores de TiempoRESUMEN
Malassezia furfur, a lipophilic fungus commonly found on the skin of healthy adult, was isolated from Broviac catheter blood cultures in five sick infants who were receiving fat emulsions intravenously. The most common manifestations of sepsis included apnea and bradycardia, low-grade fever, interstitial pneumonia, elevated neutrophil band counts, and thrombocytopenia. All infants recovered without antifungal therapy after removal of the Broviac catheters. Early onset of fungemia after catheter placement in these five infants and the recovery of M. furfur from the skin of nearly 33% of hospitalized premature neonates indicate that contamination of the Broviac catheter at time of placement may be the most likely origin of infection.
Asunto(s)
Catéteres de Permanencia/efectos adversos , Emulsiones Grasas Intravenosas , Malassezia , Micosis/sangre , Emulsiones Grasas Intravenosas/uso terapéutico , Femenino , Humanos , Lactante , Recién Nacido , Recien Nacido Prematuro , Malassezia/aislamiento & purificación , Masculino , Micosis/microbiología , Piel/microbiologíaAsunto(s)
Antibacterianos/metabolismo , Infecciones Bacterianas/tratamiento farmacológico , Enfermedades del Recién Nacido/tratamiento farmacológico , Tobramicina/metabolismo , Peso Corporal , Femenino , Semivida , Humanos , Recién Nacido , Infusiones Parenterales , Riñón/metabolismo , Cinética , Masculino , Tasa de Depuración Metabólica , Tobramicina/administración & dosificación , Tobramicina/sangreRESUMEN
The delivery rates of chloramphenicol succinate from a standard pediatric intravenous infusion set were studied in vitro at varying flow rates and injection sites of the infusion set. The pharmacokinetic properties of CAPS and chloramphenicol were then studied in 15 children given intravenous injections of CAPS via the infusion set at the flashball and Buretrol sites in a crossover fashion on successive days. In vitro, the actual times required for 95% delivery of CAPS from the infusion set were two- to fourfold longer than the predicted infusion times at flow rates of 5, 15, and 29 ml/min and at all three available injection sites. In vivo, flashball injections vs Buretrol injections resulted in significantly higher mean peak serum concentrations of CAPS and CAP, with peaks occurring significantly sooner after the beginning of the intravenous infusion. These results suggest a need for considering characteristics of CAPS infusion when monitoring and interpreting serum concentration values.