新生儿真菌感染的临床特点与耐药分析

Clinical characteristics of fungal infections in neonates and analysis of drug resistance

目的分析新生儿真菌感染的临床特点及耐药情况,为临床治疗提供参考。方法选取2014年3月-2016年12月就诊的500例新生儿,采用医院微生物半自动鉴定系统进行病原菌分离及鉴定,通过K-B纸片扩散法进行药物敏感性试验,分析患儿真菌感染的分布情况及药敏试验结果。结果 500例新生儿住院患者中,真菌感染患者32例,真菌感染率为6.40%;呼吸系统感染17例,占53.13%,泌尿系统感染9例,占28.13%,消化系统感染4例,占12.50%,血液循环系统感染2例,占6.25%;32例真菌感染新生儿标本分离真菌46株,呼吸系统共分离出31株真菌,占67.39%,泌尿系统共分离出9株真菌,占19.57%,消化系统共分离出4株真菌,占8.70%,血液循环系统共分离出2株真菌,占4.34%;药敏结果显示真菌对氟康唑,伏立康唑,伊曲康唑,两性霉素B及5-氟胞嘧啶等常见抗真菌药物均敏感;单因素分析早产儿、低体质量儿、气管插管、侵入性检查及抗菌药物连续应用2周以上与患儿发生真菌感染具有相关性,差异有统计学意义(P<0.05),非条件Logistic多元素回归分析显示:早产儿,低体质量儿,气管插管及抗菌药物连续应用2周以上是引起新生儿合并真菌感染的高危因素,差异有统计学意义(P<0.05)。结论新生儿真菌感染的高危因素较多,多以呼吸道感染为主,病原菌主要为白念珠菌,对常见抗真菌药物均敏感,耐药情况较少。

OBJECTIVE To investigate the clinical characteristics of fungal infections in neonates and analyze the drug resistance so as to provide guidance for clinical treatment.METHODS A total of 500 neonates who were treated in the hospital from Mar 2014 to Dec 2016 were enrolled in the study,the pathogens were isolated and identified by using semi-automatic microorganism identification system,the drug susceptibility testing was performed by using K-B disc diffusion method,and the distribution of the neonates with fungal infection and the result of dug susceptibility testing were observed.RESULTS Among the 500 hospitalized neonates,32 had fungal infections,with the incidence rate of fungal infections 6.40%,including 17（53.13%）cases of respiratory system infections,9（28.13%）cases of urinary system infections,4（12.50%）cases of digestive system infections,and 2（6.25%）cases of blood circulation system infections.Totally 46 strains of fungi were isolated from specimens of the 32 neonates with fungal infections,of which 31（67.39%）were isolated from respiratory system,9（19.57%）were isolated from urinary system,4（8.70%）were isolated from digestive system,and 2（4.34%）were isolated from blood circulation system.The result of the drug susceptibility testing showed that the fungi were susceptible to the commonly used antifungal agents such as fluconazole,voriconazole,itraconazole,amphotericin B and 5-fluorocytosine.Univariate analysis indicated that the incidence of the fungal infections in the neonates was associated with premature delivery,low-birth weight infant,endotracheal intubation,invasive operation,and use of antibiotics for more than 2 consecutive weeks（P〈0.05）.Non-conditional multivariate logistic regression analysis showed that the premature delivery,low-birth weight infant,endotracheal intubation,and use of antibiotics for more than 2consecutive weeks were the high-risk factors for the fungal infections in the neonates（P〈0.05）.CONCLUSION There are a variety of risk factors for the fungal infections in the neonates,the neonates with respiratory tract infections are dominant,and Candida albicans is the predominant species of pathogens and is highly susceptible to the commonly used antifungal agents.