新生儿真菌性败血症23例临床分析

Clinical analysis for fungal septicemia in 23 neonates

目的：探讨新生儿真菌性败血症的高危因素、病原谱、药物敏感性以及抗菌药物治疗效果。方法回顾性分析2009年5月至2013年8月收治的新生儿真菌性败血症患者的临床资料。结果共收治23例新生儿真菌性败血症，培养出真菌36株，其中近平滑假丝酵母菌20株（55.6%）、白色假丝酵母菌11株（30.6%）。药敏试验显示，真菌对两性霉素、五氟尿嘧啶敏感性最高，总有效率在69.4%-77.8%。23例新生儿均有早产、低出生体质量、应用广谱抗生素、有创操作等真菌性败血症的高危因素。抗真菌治疗后预后良好（存活或好转出院）15例（65.2%），预后不良（放弃或死亡）8例（34.8%）。预后良好组的平均抗真菌治疗时间高于预后不良组，差异有统计学意义（t=2.982，P〈0.05）。抗真菌治疗前及治疗后2周内，新生儿的肝肾功能及外周血白细胞变化不明显；血小板在抗真菌治疗开始后1周内即升高，与治疗前差异有统计学意义（P〈0.05）。结论新生儿真菌败血症病原菌以假丝酵母菌为主，对两性霉素敏感性较高；足疗程抗真菌治疗可提高治愈率。

Objective To investigate the risk factors, pathogens spectrum and antimicrobial susceptibility of neonatal fungal septicemia. Methods Medical records of 23 neonates with fungal septicemia from May 2009 to August 2013 were analyzed retrospectively. Results A total of 36 strains of fungi including 20 strains of Candidaparapsilosis （55.6%） and 11 strains of Candidaalbicans （30.6%） were isolated from 23 patients. Fungal pathogens were susceptible to amphotericin and lfuorouracil, with susceptibility being 69.4%-77.8%. Prematurity, low birth weight, application of broad-spectrum antibiotics and invasive operation might be the risk factors of fungal septicemia. Fifteen cases （65.2%） had good outcomes （survival or partial restoration）, while 8 cases （34.8%） had poor outcomes （withdrawing therapy or death）. The duration of antifungal therapy in good prognosis group was longer than that in poor prognosis group （t=2.982, P〈0.05）. No significant difference in indicators of liver and kidney function was observed between before antifungal therapy and within 2 weeks after treatment. Meanwhile, no signiifcant difference of WBC was found between before antifungal therapy and within 2 weeks after treatment. The platelet counts were increased within one week after initial antifungal therapy （P〈0.05）. Conclusions Candida is the main pathogen of neonatal fungal septicemia and sensitive to amphotericin B. Long enough course of antifungal therapy is necessary to improve the cure rate.