病毒性脑炎患儿合并侵袭性肺部真菌感染的临床特点分析

Clinical characteristics of children with viral encephalitis complicated with invasive pulmonary fungal infection

目的探讨病毒性脑炎患儿合并侵袭性肺部真菌感染的临床特点。方法将2015年1月至2018年1月青岛市市立医院收治的病毒性脑炎合并侵袭性肺部真菌感染患儿97例纳入研究组,另选择同期该院收治的未合并侵袭性肺部真菌感染的病毒性脑炎患儿80例纳入对照组。收集两组患儿的临床资料,包括性别、年龄及精神行为异常、脏器功能损害、肌力异常、呼吸衰竭、机械通气、白蛋白水平、使用广谱抗菌药物情况;采集两组患儿痰液标本并分离鉴定真菌,采用纸片扩散法进行耐药性试验;单因素和多因素分析探讨病毒性脑炎患儿合并侵袭性肺部真菌感染的危险因素。结果研究组97例患儿共培养出真菌116株,以白色假丝酵母菌(64株)和热带假丝酵母菌(29株)为主,其中,白色假丝酵母菌对伏立康唑耐药率较高(32.81%),热带假丝酵母菌对两性霉素B耐药率较高(48.28%)。单因素分析结果显示:两组患儿性别、年龄、精神行为异常、脏器功能损害及肌力异常比较均无显著差异(P均>0.05);两组患儿呼吸衰竭、机械通气、白蛋白水平及使用广谱抗菌药物比较均具有显著差异(P均<0.05)。多因素分析结果显示:呼吸衰竭、机械通气、白蛋白水平及使用广谱抗菌药物是影响病毒性脑炎患儿合并侵袭性肺部真菌感染的独立危险因素。结论病毒性脑炎患儿合并侵袭性肺部真菌感染的致病菌以白色假丝酵母菌和热带假丝酵母菌为主,呼吸衰竭、机械通气、白蛋白水平及使用广谱抗菌药物是病毒性脑炎患儿合并侵袭性肺部真菌感染的独立危险因素。

Objective To explore the clinical characteristics of children with viral encephalitis complicated with invasive pulmonary fungal infection. Method From March 2015 to March 2018, 97 children with viral encephalitis complicated with invasive pulmonary fungal infection in Qingdao Municipal Hospital were selected as study group, and 80 children with viral encephalitis without invasive pulmonary fungal infection in Qingdao Municipal Hospital during the same period were selected as control group. The clinical data of the two groups such a included sex, age, mental and behavioral abnormalities, organ dysfunction, muscle strength, respiratory failure, mechanical ventilation, albumin level, the use of broad-spectrum antimicrobials. Samples of sputum from children were collected, fungi were isolated and identified, drug resistance test was carried out by paper diffusion method. The risk factors of viral encephalitis complicated with invasive pulmonary fungal infection were discussed by with univariate analysis and multiplicity analysis. Result 116 strains of fungus were isolated and cultured in 97 children with viral encephalitis complicated with invasive pulmonary fungal infection, Candida albicans（64 strains） and Candida tropicalis（29 strains） were the main fungus, the resistance rate of Candida albicans to Voriconazole was higher（32.81%）, and the resistance rate of Candida tropicalis to Amphotericin B was higher（48.28%）. The univariate analysis showed that there were no significant differences in sex, age, abnormal mental behavior, organ dysfunction, abnormal muscle strength between the two groups（Pall〉 0.05）, and there were significant differences in respiratory failure, mechanical ventilation, albumin level and the use of broad-spectrum antimicrobials between the two groups（Pall 〈0.05）. Multiplicity analysis showed that respiratory failure, mechanical ventilation, albumin level, and the use of broad-spectrum antimicrobials were the risk factors of viral encephalitis complicated with invasive pulmonary fungal infection. Conclusion Candida albicans and Candida tropicalis are the main pathogens of viral encephalitis complicated with invasive pulmonary fungal infection, respiratory failure, mechanical ventilation, albumin level, and the use of broad-spectrum antimicrobials are the risk factors of viral encephalitis complicated with invasive pulmonary fungal infection.