新生儿重症监护病房内早产儿真菌脓毒症危险因素临床分析：2010年至2012年单中心报告

Analysis of risk factors and clinical characteristics in premature infants with fungal sepsis in newborn intensive care unit：a single center study from 2010 to 2012

目的 探讨早产儿真菌脓毒症的临床特点.方法 选取2010年1月至2012年12月安徽医科大学第一附属医院新生儿重症监护病房住院的30例真菌脓毒症早产儿,回顾性分析真菌脓毒症患儿的高危因素、临床表现、实验室检查、治疗与转归.结果 30例早产儿中极早产儿14例（46.7％）,早期早产儿20例（66.7％）；真菌脓毒症的发病时间为6 ～42 d,平均（15.70±9.02）d；白色假丝酵母菌是最常见的病原菌,占83.3％,其次为光滑假丝酵母菌（13.3％）.6例早产儿在真菌感染前使用气管插管机械通气治疗；9例早产儿经外周中心且置管（PICC）且置管时间≥7 d;5例早产儿使用抗生素时间≥14 d.最常见的临床表现为反应差及吃奶差或拒乳,各25例（各占83.3％）,其次为氧饱和度波动20例（66.7％）；真菌感染时,27例（90.0％）早产儿CRP升高；5例白细胞计数＜5.0 ×10^9/L,5例白细胞计数＞15.0×10^9/L;20例（66.7％）继发血小板下降.除2例因家属放弃治疗外,剩余28例（93.3％）中有4例（13.3％）因氟康唑疗效不佳改用两性霉素B脂质体治疗,24例（80.0％）单纯采用氟康唑抗真菌治疗；治疗的28例中,4例（13.3％）好转,24例（80.0％）治愈,无一例死亡.结论 白色假丝酵母菌在早产儿真菌脓毒症中所占比例较高,出生2～3周的高危早产儿,出现反应差、吃奶差及氧饱和度波动等症状时,须考虑存在真菌脓毒症的可能.高发季节对高危早产儿实施预防性抗真菌治疗,可有效降低早产儿真菌脓毒症的发生率和病死率.

Objective To investigate the clinical features of fungal sepsis in premature infants.Methods The risk factors,clinical characteristics,laboratory findings,treatment and prognosis of 30 preterm infants with fungal sepsis in neonatal intensive care unit of the First Mfiliated Hospital of Anhui Medical University from Jan.2010 to Dec.2012 were analyzed.Results Fourteen cases （46.7%） were extremely preterm infants.The gestational ages of 20 cases（66.7%） were less than 34 weeks.The preterm infants were infected with fungal sepsis at the age of 6-42 d,and the mean age was （15.70 ± 9.02） d.The most common pathogens were Candida albicans （83.3%） and Candida glabrata（13.3%）.Before infection,6 cases accepted the endotracheal intubation and mechanical ventilation,9 cases accepted Peripherally Inserted Central Catheter with the duration more than or equal to 7 days,and 5 cases accepted multi-antibiotic treatment with the duration more than or equal to 14 days,with the main clinical manifestations including poor response in 25 cases （83.3%）,poor feeding in 25 cases （83.3%）,and blood oxygen concentration decrease in 20 cases （66.7%）.There were 27 cases（90.0%） with the increased C-reactive protein（CRP）,5 preterm infants with the white blood cell count less than 5.0 × 10^9/L,5 patients with the white blood cell count more than 15.0 × 10^9/L,and 20 cases （66.7 %） with thrombocytopenia.Among those 30 cases,2 cases （6.7 %） abandoned therapy,4 cases （13.3%） accepted liposomal amphotericin B because of the poor efficacy to fluconazole,and 24 cases （80.0%） accepted fluconazole.Of the 28 cases,4 cases（13.3%） were improved,24 cases（80.0%） were cured and no one died.Conclusions The proportion of Candida albicans species increased during the cause of fungal sepsis in premature infants.It was probably the cause of fungal sepsis when preterm infants had poor response,poor feeding,blood oxygen concentration decrease in 2-3 weeks after birth.Possible strategies were recommended including strict aseptic manipulation,rational use of antibiotics,antifungal prophylaxis for preterm infants who have risk factors in highoccurrence season in order to decrease the morbidity and mortality of neonatal fungal sepsis.