新生儿真菌败血症22例临床分析

Clinical analysis of 22 cases of neonatal fungal septicemia

目的分析新生儿真菌败血症的临床特点、病原菌情况及相关因素,探讨其防治措施。方法对2005年7月至2009年9月中南大学湘雅二医院22例新生儿真菌败血症的临床资料、病原菌及药敏结果、相关因素及治疗预后情况进行回顾性研究。结果 (1)新生儿真菌败血症发生率为0.64%,占新生儿败血症的13.17%,且以医院获得性感染为主。(2)病原菌主要为念珠菌(86.4%),包括白色念珠菌、近平滑念珠菌和热带念珠菌等,药敏结果显示除1株对伊曲康唑耐药,其余对5-氟胞嘧啶、两性霉素B、氟康唑、伊曲康唑和伏立康唑均敏感。(3)早产、低出生体重、长期留置中心静脉导管、气管插管、激素使用及长疗程广谱抗生素联合使用为真菌感染的高危因素,真菌感染与院内感染具有较高的相关性。结论新生儿真菌败血症病原菌以念珠菌为主,应加强护理、严格无菌操作、合理使用激素和抗生素以及实施预防性和早期经验性抗真菌治疗,减少真菌败血症及其并发症的发生。

Objective To study the clinical characteristics of neonatal fungal septicemia, pathogens and related factors in order to provide evidence for prevention and early treatment. Methods A retrospective study including clinical data, pathogens and drug sensitivity test, risk factors for fungal infection, treatment and prognosis, was made in 22 cases of neonatal fungal septicemia in the Second Xiang＇ya Hospital, Central South University , from July 2005 to September 2009. Results The incidence of neonatal fungal septicemia in hospitalized children was 0.64% , with 13.17% of neonatal septicemia. The most common pathogens were Candida （86.4%） , such as Candida albicans, Candida parapsilosis, Candida Tropicalis and so on. Fungi were highly sensitive to antibiotics commonly used, such as Fluconazole, except that one strain was resistant to hraconazole. Preterm, low birth weight, peripherally inserted central venous catheters, mechanical ventilation, dexamethasone and muhi-antibiotic treatment were significant risk factors for fungal infection. There was significant relation between fungal infection and nosocomial infection. Conclusion Candida is the main pathogen for neonatal fungal septicemia. Possible strategies to be. considered include barrier nursing, strict aseptic manipulation, flucnnazole prophylaxis, early empirical antifungat treatment and rational use of antibiotics and hormones to prevent neonatal fungal septicemia and its complication.