儿童重症监护病房侵袭性真菌感染危险因素分析

Risk factors for invasive fungal infection in pediatric intensive care unit

目的 分析儿童重症监护病房（PICU）侵袭性真菌感染的特点及危险因素.方法 总结2007年至2009年我院PICU收治的35例发生侵袭性真菌感染患儿的临床资料,对真菌感染危险因素进行分析,包括危重病例评分、机械通气、导尿管和胃管置入、床旁血液净化治疗等.结果 （1）3年间PICU共收治危重患儿2 116例,其中35例发生真菌感染,发生率为1.65%（35/2 116）,其中死亡7例,病死率为20.00%（7/35）.（2）发生真菌感染的平均时间为人院后（10.4±8.3）d,主要表现为肺炎21例（60.0%）,腹膜炎5例（14.3%）,尿路感染4例（11.4%）,肠道感染3例（8.6%）,败血症1例（2.9%）,脑膜炎1例（2.9%）.（3）儿童危重病例评分低、机械通气、留置胃管及导尿管、连续性静脉血液透析滤过是引起真菌感染的危险因素.（4）致病菌以白色念珠菌为主.结论 侵袭性真菌感染已成为PICU主要的院内感染,白色念珠菌是主要致病菌.合理利用抗生素、减少不必要的侵入性操作、及时使用抗真菌药,可能是应对侵袭性真菌感染的有效策略.

Objective To analyze the incidence,clinical feature and the risk factors of invasive fungal infection in pediatric intensive care unit （PICU）. Methods We retrospectively summaried the invasive fungal infection in our PICU from Jan 2007 to Dec 2009 in order to analyze the incidence, clinical feature and the risk factors of invasive fungal infection in PICU. Multiple clinical data were collected such as pediatric critical illness score, mechanical ventilation, urinary drainage tube, indwelling gastric canal and continuous blood purification. Results （ 1 ） The incidence rate of invasive fungal infection was 1.65 % （ 35/2 116 ）. The morbidity was 20. 00% （ 7/35 ）. （ 2 ） Mean infected day was （ 10. 4 ±- 8. 3 ） d after admission. The clinical manifestations included fungal pneumonia（ 60. 0% ）, peritonitis （ 14. 3% ）, urinary tract infection （ 11.4% ）,intestinal tract infection（8. 6% ） ,sepsis（2. 9% ） and meningitis（2. 9% ）. All of the patients had used broad spectrum antibiotic. （3） The risk factors of invasive fungal infection included lower pediatric critical illness score, mechanical ventilation, indwelling gastric tube, urinary drainage tube and continuous blood purification.（4） Candia albicans was the predominant pathogen in invasive fungal infection. Conclusion Invasive fungal infection has become one of the main nosocomial infection in PICU. Lung is most commonly involved and candida albicans is the major pathogen. Using antibiotics appropriately, decreasing unnecessary invasive performance,and rationally using antifungal agent mi.ght be effective strategy for invasive fungal infection in PICU.