早产儿真菌血症临床特点

Clinical characteristics of fungemia in premature infants

目的了解早产儿真菌血症患儿临床特点。方法回顾性分析2011年1月—2015年12月某儿童医院重症监护病房早产儿真菌血症的临床特点,比较早产儿的一般情况、实验室相关指标及药敏结果。结果 2011年1月—2015年12月该院收治确诊的真菌血症早产儿42例,其中白假丝酵母菌22例(占52.38%),近平滑假丝酵母菌13例(占30.95%),克柔假丝酵母菌3例,其他4例。按感染的主要病原菌进行分组,分为近平滑假丝酵母菌组和白假丝酵母菌组。白假丝酵母菌组母亲泌尿生殖系感染率、真菌性脑膜炎的发生率均为27.27%,高于近平滑假丝酵母菌组(分别为7.69%、0.00%),白假丝酵母菌组经外周静脉置入中心静脉导管(PICC)置管率低于近平滑假丝酵母菌组(22.73%vs 69.23%),近平滑假丝酵母菌组血小板计数低于白假丝酵母菌组,差异均有统计学意义(均P<0.05)。结论早产儿真菌血症感染病原菌以近平滑假丝酵母菌和白假丝酵母菌为主,母亲孕期生殖系感染易导致白假丝酵母菌血症的发生,白假丝酵母菌血症早产儿更易患真菌性脑膜炎;PICC置管更易导致近平滑假丝酵母菌血症的发生,血小板的下降更明显。

Objective To realize the clinical characteristics of fungemia in premature infants.Methods Clinical characteristics of fungemia in premature infants in the intensive care unit of a children＇＇s hospital between January 2011 and December 2015 were analyzed retrospectively, general condition of premature infants, laboratory-related indicators, and antimicrobial susceptibility testing results were compared.Results From January 2011 to December 2015, 42 premature infants with confirmed fungemia were treated in this hospital, 22 （52.38%） of whom were with fungemia caused by Candida albicans（C.albicans）, 13 （30.95%） by Candida parapsilosis （C.parapsilosis）, 3 by Candida krusei （C.krusei）, and 4 by other fungi.Patients were grouped according to the main pathogens causing infection： C.parapsilosis group and C.albicans group.Maternal genitourinary tract infection rate and incidence of fungal meningitis in C.albicans group were both higher than C.parapsilosis group（27.27% vs 7.69%, 27.27% vs 0.00% respectively）, peripherally inserted central catheter （PICC） rate in C.albicans group was lower than that in C.parapsilosis group（22.73% vs 69.23%）, platelet count in C.parapsilosis group was lower than C.albicans group, differences were all statistically significant （all P〈0.05）.Conclusion The major fungi causing fungemia in premature infants were C.parapsilosis and C.albicans, maternal reproductive system infection during pregnancy can easily lead to candidemia, premature infants with candidemia are more vulnerable to developing fungal meningitis;PICC is more likely to lead to C.parapsilosis fungemia, and platelet decline is more obvious.