小婴儿院内深部真菌感染的危险因素

Risk Factors of Nosocomial Invasive Fungal Infection in Infants

目的探讨PICU住院患儿的院内深部真菌感染（NIFI）的流行病学及其高危因素。方法对2006年7月1日-2008年6月30日在广东省人民医院PICU住院符合NIFI诊断标准的68例婴儿进行回顾性分析。分析其一般情况、感染前诊疗经过、真菌菌株类型、标本类型的情况。结果 2006年7月1日-2008年6月30日本院PICU住院患儿NIFI发病率为3.31%（68/2 052例次）。NIFI患儿总住院时间中位数为16 d（3~58 d）,四分位数间距为13 d,较同期住院患儿[中位数9 d（1-165 d）,四分位数间距17 d]显著延长（Z=-4.175,P=0.000）。心血管疾病比例为86.8%（59/68例）,呼吸系统疾病比例为52.9%（36/68例）,脓毒症等其他疾病比例为33.8%（23/68例）;以心血管疾病为基础病的患儿NIFI发生率为11.39%（59/518例）,较同期住院的其他基础疾病患儿NIFI发病率显著升高（2χ=141.056,P=0.000）。感染真菌前广谱抗生素使用率为98.5%（67/68例）,抗生素联合应用占66.2%（45/68例）,抗生素使用时间≥7 d者占80.9%。胃肠外营养使用率为94.1%（64/68例）,77.9%（53/68例）的患儿接受心脏手术,中心静脉置管率为70.6%（48/68例）,激素使用率为70.6%（48/68例）,机械通气率为63.2%（43/68例）,尿管留置率为48.5%（33/68例）。结论 PICU中NIFI发病率呈逐渐上升趋势。危重原发病,尤其是先天性心脏病围手术期,较长的住院时间、机械通气、抗生素尤其广谱抗生素的大量使用、激素、胃肠外营养及深部留置管道等诊疗手段是发生NIFI的高危因素。

Objective To explore the epidemiology of nosocomial invasive fungal infection（NIFI） in the PICU and analyze the risk factors and provide evidence for proper diagnosis and treatment.Methods A group of total 68 infants with NIFI,who were hospitalized in Guangdong General Hospital from Jul.2006 to Jun.2008 were retrospectively analyzed.All the medical records of the 68 cases,such as the general condition,previous treatment,types of fungal strains,as well as the types of samples were analyzed.Results The incidence rate of NIFI was 3.31%（68/2 052 cases）.The median hospital stay before NIFI was 16 days in the 68 cases,and interquartile range was 13 days,which was longer than that other patients [median time was 9 d（1-165 d）,interquartile range was 17 d]（Z=-4.175,P=0.000）.All the 68 patients suffered from more than one critical primary diseases,86.8%（59/68 cases） were congenital cardiovascular disease,52.9%（36/68 cases）with respiratory diseases,33.8%（23/68 cases） with sepsis and other disease.The incidence rate of NIFI in children with congenital cardiovascular disease was 11.39%（59/518 cases）,which was higher than that in other patients（χ2=141.056,P=0.000）;98.5%（67/68 cases） children received broad antimicrobial spectrum antibiotics,66.2%（45/68 cases） used more than one kind of antibiotics,and 80.9% used antibiotics for at least 7 days.Of the 68 children,94.1%（64/68 cases） received parenteral nutrition,77.9%（53/68 cases） received cardiovascular operations,70.6%（48/68 cases） received indwelling central venous catheter,70.6%（48/68 cases） received glucocorticoid,63.2%（43/68 cases） received mechanical ventilation,48.5%（33/68 cases）received indwelling urinary catheter.Conclusions The incidence of NIFI is increasing in PICU.The critical primary disease,especially perioperation of congenital heart disease,the long duration in hospital,a great deal of antibiotics,parenteral nutrition,glucocorticoid and catheters are probably the risk factors for NIFI in PICU.