新生儿重症监护病房侵袭性真菌感染易感因素及早期诊断探讨

Clinical study on risk factors and early diagnosis of invasive fungal infection in neonatal intensive care unit

目的探讨新生儿侵袭性真菌感染的易感因素及早期诊断措施。方法对24例新生儿侵袭性真菌感染的高危因素、临床资料及治疗预后进行回顾性分析。结果 2009年1月1日—2010年12月31日新生儿重症监护病房(NICU)收治新生儿真菌感染24例,占NICU同期收治新生儿0.66%(24/3 635)。210例同时做血培养和(1,3)-β-D葡聚糖含量检测,送检率5.8%(210/3 635);(1,3)-β-D葡聚糖阳性24例,阳性率11.4%(24/210);血培养阳性8例,阳性率3.8%(8/210),(1,3)-β-D葡聚糖阳性率显著高于血培养阳性率(P<0.05)。病原菌中念珠菌5例(光滑念珠菌3例,热带念珠菌1例,克柔念珠菌1例),白假丝酵母菌2例,毛霉菌1例,对氟康唑等常用抗真菌药均敏感。24例侵袭性真菌感染新生儿均联合应用三代头孢菌素7 d以上(100.0%),早产儿20例(83.3%),气管插管机械通气19例(79.2%),留置中心静脉导管17例(70.8%)。早产、低出生体质量、留置中心静脉导管、气管插管机械通气及长期联合使用广谱抗生素为新生儿侵袭性真菌感染的高危因素。结论新生儿侵袭性真菌感染以早产儿为主,病原菌以念珠菌为主;(1,3)-β-D葡聚糖含量检测在新生儿侵袭性真菌感染的早期诊断中敏感性高、特异性强,动态观察更容易早期发现异常。临床上合理使用抗生素,及时检测(1,3)-β-D葡聚糖含量,有利于NICU中新生儿侵袭性真菌感染的早期诊断和减少误诊漏诊率。

Objective To analyze the clinical features and risk factors,and to explore the measures on early diagnosis of invasive fungal infection in NICU（neonatal intensive care unit）.Methods Clinical manifestations,risk factors,diagnosis and treatment of 24 neonates with invasive fungal infection were analyzed retrospectively.Results 3 635 patients were admitted to NICU in the past 2 years（from 1/1/2009 to 12/31/2010）.Incidence of invasive fungal infection in NICU was 0.66%（24/3 635）.Both blood culture and（1,3）-β-D glucan were detected in 210 neonates,with inspection rate of 5.8%.24 cases were infected,with positive rate of 11.4%（24/210）.And 8 cases were found through blood culture,with positive rate of 3.8%（8/210）.Positive rate of（1,3）-β-D glucan was significantly higher than that of blood culture（P 0.05）.Candida were found in 5 cases（3 cases of Candida glabrata,1 case of Candida tropicalis,and 1 case of Candida krusei）,Candida albicans in 2 cases,and Mucor in 1 case.And all the 8 patients were sensitive to fluconazole and other commonly used antifungal drugs.Among the 24 cases with invasive fungal infection,24 cases had received joint use of 3rd generation Cephalosporins over 7 days（100%）,20 cases were premature（83.3%）,17 cases received indwelling central venous catheter（70.8%）,19 cases received endotracheal intubation with mechanical ventilation（79.1%）.Preterm birth,low birth weight,indwelling central venous catheters,endotracheal intubation with mechanical ventilation and long-term joint use of broad-spectrum antibiotics were risk factors in predicting invasive fungal infection.Conclusions Neonates in NICU,especially premature neonates are susceptible to deep fungal infection,and the main pathogen is Candida.The（1,3）-β-D glucan test is more sensitive and specific than blood culture for early diagnosis of invasive fungal infection.Dynamic observation is helpful to diagnose invasive fungal infection early.Rational clinical use of antibiotics helps to reduce the rate of invasive fungal infection.The（1,3）-β-D glucan test is useful for early diagnosis of invasive fungal infection.