160例新生儿真菌性肺炎的高危因素分析

Risk factors for fungal pneumonia in neonates:analysis of 160 cases

目的探讨新生儿真菌性肺炎的相关高危因素。方法将260例院内感染性肺炎分为真菌性肺炎组和非真菌性肺炎组。分别对每组病例一般情况、抗生素的应用、原发病等因素进行分析。结果①在住院天数、是否早产、体重方面两组差异显著。②使用第三代头孢菌素+酶抑制剂、半合成青霉素+酶抑制剂、碳青酶烯类,联合使用两种广谱抗菌药物和抗生素总的使用天数在医院获得性真菌性肺炎组使用时间较细菌组长,差异有统计学意义。③新生儿真菌性肺炎的原发病多为医院获得性细菌性肺炎,二者有高度的相关性。结论早产儿、低体重儿、住院时间长、长时间使用抗生素包括三代头孢类抗菌药物、两种抗生素联合应用或碳青酶烯类抗菌药物可增加医院感染性真菌性肺炎发生的危险性。新生儿真菌性肺炎的发生和新生儿医院获得性细菌性肺炎有相关性。

Objective To study the risk factors for the development of fungal pneumonia in neonates. Methods A total of 260 neonates with nosocomial infectious pneumonia were classified into two groups： fungal pneumonia （n = 160 ） and bacterial pneumonia （n = 100 ）. Their medical data were retrospectively studied. Results Eighty-seven percent of patients in the fungal pneumonia group had a duration of hospital stay of 〉 10 days, but 30.1% of patients in the bacterial pneumonia group （P 〈 0.01 ）. The preterm infants in the fungal pneumonia group accounted for 49.5% , which was significantly higher than that in the bacterial pneumonia group （ 22.0% ） （ P 〈 0.01 ）. In the fungal pneumonia group, 59.9% of patients showed a weight of 〈 2 500 g, but 34.0% of patients in the bacterial pneumonia group （P 〈 0.01 ）. The duration of the combined use of more than two broad-spectrum antibiotics （ P 〈 0.05 ） and the total duration of antibiotics use in the fungal pneumonia group was significantly longer than that in the bacterial pneumonia group （P 〈 0.05 ）. Nosocomial infectious bacterial pneumonia was common as the primary disease of fungal pneumonia （ n = 145 ）. Conclusions Premature delivery, lower weight, longer duration of hospital stay and antibiotics use, and combined use of more than two broad-spectrum antibiotics may increase the risk of fungal pneumonia in neonates. The development of fungal pneumonia may be related to nosocomial infectious bacterial pneumonia in neonates.