新生儿重症监护室内假丝酵母菌败血症感染九例分析

Clinical characteristics of Candida septicemia seen in a neonatal intensive care unit:analysis of 9 cases

目的分析新生儿重症监护室内假丝酵母菌败血症的临床特点。方法总结9例确诊病例的临床特征,进行易感因素分析。结果 9例均为早产儿,极低出生体重儿6例。9例真菌感染前全部接受广谱抗生素治疗及静脉营养,8例留置中心静脉导管(PICC,percutaneous inserted centralcatheter),3例曾机械通气。生后8～22 d 出现呼吸暂停、灌注差、反应差等症状,7例血小板减少,7例 C 反应蛋白升高。血培养白色假丝酵母菌1例,近平滑假丝酵母菌2例,季也蒙假丝酵母菌6例,5例 PICC 导管尖端培养和血培养同时阳性,且为同一菌株。9例均接受抗真菌及对症支持治疗,6例治愈,1例放弃治疗自动出院,2例死亡。结论新生儿假丝酵母菌败血症的高危因素包括早产、留置PICC、长期应用广谱抗生素、机械通气等,症状常不典型,可伴有血小板减少,C 反应蛋白轻中度升高等,早期积极治疗预后较好。

Objective To analyze the clinical characteristics of Candida septicemia occurred in neonatal intensive care unit （NICU）. Methods The clinical characteristics of 9 confirmed cases with septicemia caused by Candida species yeasts were analyzed and summarized. Results All the 9 cases were preterm infants, including 6 cases of very low birth weight infants. All these cases were treated with broad-spectrum antibiotics and parenteral nutrition before fungal infections occurred. Eight cases had percutaneous inserted central catheter （ PICC ）. Three cases had been on ventilator. The symptoms of fungal infection were presented at 8 to 22 days of age. Apnea, poor perfusion and lethargy were common symptoms of these cases with fungal infection. Seven of the 9 cases developed thrombocytopenia. C reactive protein was elevated in 7 cases. Blood culture showed C. albicans in 1 case, C. parapsilosis in 2 cases, and C. guilliermondii in 6 cases. In 5 cases PICC culture showed the same fungus as blood culture revealed at the same time. All the 9 patients received antifungal therapy. Six patients were cured, two died and in one patient the treatments were given up by the parents. Conclusions The high risk factors of Candida septicemia in newborn infants include preterm, PICC, broad-spectrum antibiotic therapy and mechanical ventilation. The clinical presentations are always nonspecific. Thrombocytopenia and elevated C reactive protein are common in Candida septicemia patients. Early-started antifungal therapy can improve the prognosis.