早产儿院内真菌感染72例病原菌及耐药性分析

Pathogenic bacteria and drug resistance analysis of 72 cases of premature infants with nosocomial fun- gal infection

目的了解早产儿院内真菌感染病原菌分布特点及抗生素耐药情况，为早产儿院内真菌感染的防治提供依据。方法对发生院内真菌感染的72例早产儿的临床资料进行回顾性分析。结果我院早产儿真菌感染前3位的病原菌分别为菌假丝酵母菌38株（52．8％，38／72），白假丝酵母菌10株（13．9％，10／72），近平滑假丝酵母菌9株（12．5％，9／72）。72例院内真菌感染早产儿的体重均在2000g以下，其中以极低出生体重儿为主；胎龄以27-30周居多，其中27—28周占36．1％（26／72），29—30周占34．7％（25／72），各组病原菌均以菌假丝酵母菌为主。分离出的72株真菌未见对两性霉素B耐药，对氟康唑耐药率为1．4％（1／72）、对伏立康唑耐药率为4．2％（3／72）、对伊曲康唑耐药率为2．8％（2／72），后3者耐药率间差异无统计学意义（χ2=1．02，P〉0．05）；对5-氟胞嘧啶耐药者占59．7％（43／72），与上述4种药物耐药率间的差异有统计学意义（χ2=57．73，P〈0．005）；而两性霉素B与氟康唑间耐药率差异无统计学意义（χ2=1．01，P〉0．05）。结论对有院内真菌感染高危因素的早产儿可预防性应用氟康唑，对明确真菌感染的早产儿首选静脉给予氟康唑治疗尤其是合并中枢神经系统真菌感染时，必要时可联合应用两性霉素B。

Objective To understand the distribution of pathogen and antibiotic resistance of nosoco- mial fungal infection, and provide evidence for the prevention of fungal infection in premature infants in hos- pital. Methods The clinical data of 72 cases of premature infants with nosocomial fungal infections were ret- rospectively analyzed. Results The top three of the pathogenic of fungal infection in premature infants in our hospital were 38 strains of Candida pelliculosa （52. 8% ,38/72） ,10 strains of Candida albicans （ 13.9% ,10/72）, 9 strains of Candida parapsilosis （12. 5% ,9/72）. The weights of 72 cases with nosocomial fungal infection in preterm infants were below 2000 g, who were dominated by very low birth weight infants. Gestational age of 27 - 30 weeks were in the majority, which accounted for 36. 1% of 27 - 28 weeks （26/72） and 34. 7% of 29 - 30 weeks （ 25/72 ）, each group were dominated by bacteria pathogen candida. Seventy-two strains of fungi were isolated to amphotericin B drug resistance, the 1.4% （ 1/72 ） resistance rate to fluconazole, 4. 2% （3/72） pairs of voriconazole resistance rate, 2. 8% （2/72） for itraconazole resistant rate. There were no significant differences among the last three resistant rate （ χ2 = 1.02, P 〉 0. 05 ）. The 5-fluorine cytosine resistance accounted for 59. 7% （43/72）, and the 4 kinds of drug resistance rate had significant difference （ χ2 = 57.73, P 〈 0. 05 ）. There was no significant difference in resistance rate between amphotericin B and fluconazole （ χ2 = 1.01 ,P 〉 0.05 ）. Conclusion Fluconazole could be used to those premature infants with high risk factors of fungal infection. Once the fungal infection is diagnosed,intravenous fluconazole could be the first choice, when necessary, amphotericin B can be used together.