新生儿菌膜假丝酵母菌感染分析及干预评价

Causes of Candida pelliculosa infections in neonates and intervention measures

目的分析新生儿病房菌膜假丝酵母菌感染播散原因,确定有效的预防控制措施,降低医院感染率。方法调查新生儿病房2012年1-8月菌膜假丝酵母菌感染患儿的一般资料、临床表现、实验室检查、侵入性操作、环境病原菌检测及分析菌膜假丝酵母菌感染的危险因素,并评估在加强综合干预措施基础上增加手卫生依从性监测对菌膜假丝酵母菌感染的干预效果。结果菌膜假丝酵母菌感染29例,早产儿占93.1%,23例感染表现呼吸暂停或周期样呼吸,感染前100.0%应用PICC和胃肠外营养(TPN),所有患儿均使用≥1种的广谱抗菌药物,环境监测未检出病原菌;采用手卫生依从性监测干预后感染病例及感染率均逐渐减少。结论早产儿是假丝酵母菌属感染的高危人群,使用PICC、TPN及使用广谱抗菌药物可能是假丝酵母菌属感染的高危因素,手卫生依从性监测干预可以有效降低新生儿真菌感染。

OBJECTIVE To analyze the causes of dissemination of Candida pelliculosa in a neonatal ward and determine the effective prevention and control measures so as to reduce the incidence of nosocomial infections. METHODS The neonates with Candida pelliculosa infections who were treated in the neonatal ward from Jan 2012 to Aug 2012 were enrolled in the study, then the general data, clinical manifestations, laboratory findings, invasive procedure, and detection of environmental pathogens were investigated, the risk factors for the Candida pelliculosa infections were analyzed, and the effect of the enhanced integrated intervention combined with monitoring of hand hygiene compliance was observed. RESULTS Of totally 29 neonates with Candida pelliculosa infections, the premature neonates accounted for 93. 1%, there were 23 cases with the clinical manifestations presenting as apnea or cycle like breathing. 100.0 ~ of the neonates underwent PICC and were given the parenteral nutrition （TPN） before the onset of infections, all the neonates have used more than one broad spectrum antibiotics, and no strains of pathogens were detected through the environmental surveillance. The cases of infections and the incidence of infections have been gradually reduced through the surveillance of hand hygiene compliance. CONCLUSION The premature neonates are the population at high risk of Candida pelliculosa infections~ the use of PICC, TPN, and use of broad spectrum antibiotics may be the high risk factors for the Can- dida pelliculosa infections, and the surveillance of hand hygiene compliance may contribute to the reduction of incidence of fungal infections in the neonates.