新生儿侵袭性真菌感染危险因素分析

Analysis of risk factors of invasive fungal infection in newborns

目的探讨新生儿侵袭性真菌感染（IFI）的危险因素,为建立IFI临床防治方案提供依据。方法选择2012年1月至2015年3月,在广西壮族自治区妇幼保健院新生儿科确诊为IFI的66例患儿为研究对象,纳入观察组。采用随机数字表法选取同期于本院住院的66例非真菌感染新生儿,纳入对照组。对两组新生儿的孕母情况、一般临床资料及新生儿住院治疗情况,共计18项临床指标进行回顾性分析,并采用非条件多因素logistic回归分析法,分析新生儿IFI的独立危险因素。本研究遵循的程序符合广西壮族自治区妇幼保健院人体试验委员会制定的伦理学标准,得到该委员会批准,征得受试对象监护人知情同意,并与之签署临床研究知情同意书。结果 1观察组新生儿出生体重低于对照组,而宫内感染发生率、新生儿窒息发生率、住院天数、机械通气使用率及时间、持续气道正压通气（CPAP）使用率及时间、经外周静脉穿刺中心静脉置管（PICC）使用率及留置时间与广谱抗菌药物使用时间,均长于或高于对照组,且差异有统计学意义（P〈0.05）。其他7项临床指标,包括孕母年龄、孕母孕期合并其他疾病发生率、单胎妊娠率、自然分娩率、新生儿胎龄、男性新生儿比例及新生儿广谱抗菌药物使用率,两组比较,差异均无统计学意义（P〉0.05）。2非条件多因素logistic回归分析结果显示：新生儿住院天数（OR=1.317,95%CI：1.036-1.673,P〈0.05）,新生儿广谱抗菌药物使用时间（OR=2.148,95%CI：1.010-3.145,P〈0.05）是新生儿IFI的独立危险因素。结论对具有真菌感染高危因素的新生儿,应尽量避免滥用广谱抗菌药物、缩短住院时间,以减少真菌感染发生率。

Objective To analyze the risk factors of neonatal with invasive fungal infections（IFI）,to provide a reference for the best programme in the clinical prevention and cure of IFI in newborn.Methods A total of 66 neonates who were diagnosed as IFI from January 2012 to March2015in the neonatal ward of the Maternal Child Health Hospital of Guangxi Zhuang Autonomous Region,were chosen as study objects and bringing into observation group.Meanwhile,another 66 neonates in the same period and the same hospital without IFI were randomly bringing into control group by random number table method.There were 18 clinical factors which would be studied retrospectively about mother′s conditions,general clinical data and hospitalization conditions of neonates in two groups,and adopting unconditional multivariate logistic regression analysis model to analyze the independent risk factors for neonatal IFI.Our study was in line with the Maternal Child Health Hospital of Guangxi Zhuang Autonomous Region′s Ethics Standards promulgated by the human subjects committee,approved by the committee,and obtained the informed consents from the neonate′s guardian.Results 1The birth weight of neonates in observation group was lower than that of control group,but the incidence rates of intrauterine infection and neonatal asphyxia,duration of hospitalization,usage rates and duration of mechanical ventilation,usage rates and duration of continuous positive airway pressure（CPAP）,usage rates and retention time of peripherally inserted central catheter（PICC）,and the using time of the broad spectrum antibacterials of observation group were longer or higher than those of control group,all of the differences above were statistically significant（P〈0.05）.There were no significant differences between two groups in another seven clinical indexes,including maternal age,incidence rate of complicated with other disease of the maternal in the pregnancy,singleton pregnancy rates,rates of natural childbirth,gestational age,the proportion of male babies and usage rates of broad spectrum antibacterials（P〈0.05）.2The results of the unconditional multivariate logistic regression analysis showed that：duration of hospitalization（OR=1.317,95%CI：1.036-1.673,P〈0.05）and using time of the broad spectrum antibacterials（OR=2.148,95%CI：1.010-3.145,P〈0.05）were independent risk factors of the neonate IFI.Conclusions To reduce the rate of fungal infection,the broad-spectrum antimicrobial agents should be prevented from abuse and the duration of hospitalization should be shorten for the neonates with high risk factors of fungal infection.