新生儿血液近平滑假丝酵母菌感染的临床特点及药敏分析

Clinical characteristic and antifungal drug sensitivity of candida parapsilosis infections in blood of neonates

目的 了解新生儿血液近平滑假丝酵母菌感染的临床特点和药敏结果,为临床预防和诊治提供参考.方法 对8例新生儿血培养中分离出的近平滑假丝酵母菌进行药敏分析,并回顾性分析感染患儿的临床特点.血培养采用BD9120血培养仪,沙保罗培养基分离培养,科玛嘉（CHROMagar）酵母菌显色培养基及API20C真菌鉴定板,药敏试验采用FUNGUS3微量稀释版.结果 近平滑假丝酵母菌抗真菌药敏结果分别为5-氟胞嘧啶≤4 μg/ml,两性霉素B≤0.5 μg/mL,氟康唑≤1～2.0μg/ml,伊曲康唑≤0.125～0.125 μg/ml,伏立康唑≤0.06～0.06 μg/ml.7例为早产儿（低出生体重或超低出生体重儿）,1例足月先天幽门闭锁术后患儿.8例患儿血培养前均应用广谱抗生素和静脉营养治疗,均曾留置中心静脉导管,3例曾应用机械通气.4例用氟康唑,3例氟康唑联合两性霉素B脂质体,1例先用氟康唑后用威凡,8例患儿全部治愈.结论 近平滑假丝酵母菌已成为早产、低出生体重儿血液真菌感染的主要病原菌之一,对5种常用抗真菌药物体外药敏试验均敏感,及早发现和治疗愈后较好.

Objective To study the clinical characteristic and antifungal drug sensitivity of neonatal Candida parapsilosis infections in blood and to provide reference for clinical prevention and therapy.Methods The drug resistance of Candida parapsilosis which were isolated from 8 neonatal blood specimen on the laboratory were analyzed and clinical characteristic of infections in neonates were investigated retrospectively.The blood cultured with BD9120.The fungi were isolated with Sabourand Dextrose Agar and CHROMagar colored medium and identified with API20C.The susceptibility test was then performed with FUNGUS3 micro dilution plate.Results Candida parapsilosis susceptibility results to antifungal drugs showed that 5-flucytosine≤ 4 μg/ml,amphotericin B ≤ 0.5 μg/ml,fluconazole ≤ 1 ～ 2.0 μg/ml,itraconazole ≤ 0.125 ～0.125 μg/ml,voriconazole ≤0.06 ～0.06 μg/ml.Seven cases were preterm infants（low birth weight infants or extremely low birth weight infants）,one case was term infant after operation of congenital pyloric atresia.Before blood culture,all the 8 cases of Candida parapsilosis sepsis had received broad-spectrum antibiotics and intravenous nutrition.All the 8 cases had received peripherally inserted central catheter,and 3 cases had received mechanical ventilation.Four cases with fluconazole,3 cases with fluconazole and amphotericin B,1 case with fluconazole at the onset but changed VFend,all 8 cases were cured.Conclusion Candida parapsilosis has become the one of the main pathogens of neonatal infection fungal in blood of premature or low birth weight infants,which is sensitive to 5 kinds of antifungal drugs in vitro susceptibility test.Early detection and antifungal therapy can improve the prognosis.