26例儿童深部真菌感染的临床病例分析

Analysis of 26 cases of deep fungal infections in children

目的探讨儿童深部真菌感染种类及导致感染的危险因素。方法回顾性调查分析2005～2010年间26例已确诊为深部真菌感染的住院儿童临床资料,分析其深部真菌感染种类及危险因素。结果真菌感染种类:在26例真菌感染患者中,白色念珠菌20例,占76.92%;热带念珠菌4例,占15.38%;毛霉菌和新型隐球菌感染各1例,各占3.85%。危险因素分析:在26例感染患者中,进行过侵入性操作,占92.30%;使用了2种及2种以上广谱抗生素≥4d,占88.46%;在使用了2种及2种以上广谱抗生素≥4d后体温在38℃以上的,占65.38%;手术患者,占50%;应用过呼吸机,占50%。26例经抗真菌治疗:治愈21例占,80.77%;自动出院2例,占7.7%;死亡3例,占11.54%。结论住院儿童深部真菌感染与各种侵入性操作、长时间使用多种抗生素、手术和使用呼吸机等多种危险因素有关。早期诊断及合理选用抗真菌药物是治愈的关键。

Objective To investigate the clinical characteristics of deep fungal infections in children.Methods Clinical data of 26 cases of children with deep fungal infections between 2005 and 2010 were retrospectively studied.Results Among the 26 cases of patients with deep fungal infections, there were 20 cases（76.92%） of Candida albicans infection and 4 cases（15.38） of Candida tropicalis infection and each 1 case of Cryptococcus meningitides and mucor infection. Among related risk factors, 92.3% were with operation, 77.46% were with usage of broad-spectrum antibiotics for more than 4 days, 65.38% were with temperature more than 38 ℃ when broad-spectrum antibiotics were used for at least four days, 50% were with operation or usage of mechanical ventilation. All of the 26 cases of child patients accepted antifungal treatment, among whom 3 cases（11.54%） died, 2 cases（7.7%） gave up therapy and 21 cases（80.77%） were cured.Conclusion Several risk factors, such as long time usage of antibiotics, invasive operation, surgery and mechanical ventilation, might play important roles in deep fungal infection in children. Early diagnosis and effective management were the key factors for curing of children with deep fungal infections.