早产儿真菌败血症23例临床分析

Clinical analysis of 23 cases of fungal sepsis in preterm neonates

目的研究新生儿重症监护病房(NICU)病房早产儿真菌败血症的临床特点、高危因素、病原菌及药敏情况,指导临床防治。方法分析本院NICU病房2012年5月-2015年5月早产儿临床资料,以同期住院早产儿为对照,总结真菌败血症的高危因素、病原分布、药敏结果等加以统计分析。结果收治早产儿2 534例,经血培养确诊为真菌败血症23例,均为医院感染。其中极低出生体重儿(VLBW)早产儿14例,超低出生体重(ELBW)早产儿5例。与同期住院早产儿比较,低出生体重儿、小胎龄、静脉置管及长期静脉营养是真菌败血症的高危因素;病原均为假丝酵母菌,其中近平滑假丝酵母菌16例(69.6%),白色念珠菌6例(26.1%),无名假丝酵母菌1例(4.3%),药敏试验均对氟康唑敏感。结论极低及超低出生体重儿是院内感染真菌败血症的好发人群。病原菌以假丝酵母菌为主,对氟康唑普遍敏感。足疗程抗真菌治疗可改善预后。

Objective To investigate the clinical characteristics and pathogens and risk factors of fungal sepsis in preterm neonates and provide evidence for early diagnosis and treatment. Methods All preterm infants from May 2012 to May 2015 were selected.Pathogens and clinical features were observed and analyzed,and the outcomes were recorded. Results A total of 2 534 cases were admitted.Among the 23 infants diagnosed with positive blood,14 were very low birth weight（VLBW）infants and 5were extremely low birth（ELBW）infants.Compared with the preterm infants without fungal sepsis,low birth weight,small gestational age,venous catheter and long-term parenteral nutrition were the risk factors.23 cases of fungal sepsis were due to Candidiasis,including 16（69.6%）Candida parapsilosis,6（26.1%）Candida albicans,1（4.3%）Candida nameless.All of the Candidiasis were sensitive to Fluconazole. Conclusion VLBW/ELBW preterm infants are susceptible of fungal septicemia.Venous catheter and long-term parenteral nutrition are the risk factors.The full treatment course can improve the prognosis.