新生儿真菌性败血症30例临床特点分析

Analysis of clinical feature of 30 neonates with fungal sepsis

目的分析新生儿真菌性败血症的临床特点,提高对新生儿真菌性败血症的认识水平。方法分析30例新生儿真菌性败血症的临床资料,包括临床表现、实验室检查结果、治疗转归等。同时选取78例早产儿细菌性败血症患儿,比较实验室检查结果。结果所有病例中早产儿25例(83.3%),低出生体重儿28例(93.3%)。发病危险因素有:广谱抗生素应用29例(96.7%)、气管插管18例(60.0%)、中心静脉置管14例(46.7%)等。临床表现有发热、呼吸暂停、呼吸浅促等。与早产儿细菌性败血症病例对比,真菌性败血症组降钙素原升高者少,血小板下降者更多(P<0.01)。9例行G试验,8例(88.9%)阳性。病原菌均为念珠菌,其中白色念珠菌19株(63.3%),非白色念珠菌11株(36.7%)。药敏结果:白色念珠菌对两性霉素B均保持敏感,但对氟康唑14例敏感,2例中介,3例耐药。非白色念珠菌对所测试药物均敏感。治疗转归:共25例患儿治愈,治愈率83.3%。结论新生儿真菌性败血症临床表现缺乏特异性,G试验及降钙素原、血小板计数对诊断有一定帮助。病原菌以白色念珠菌为主,部分菌株存在耐药。治疗需按照药敏选择合适药物。

Objective To analyze clinical feature of 30 neonates with fungal sepsis,in order to improve the level of diagnosis and treatment.Methods Totally 30 neonates with fungal sepsis and 78 premature infants with fungal sepsis were included in this study.Clinical manifestations,pathogens,laboratory findings and treatment outcomes were analyzed.The differences of laboratory parameters between fungal sepsis and bacterial sepsis were also analyzed.Results Of these cases,25 cases（83.3%）were premature infants,and 28 cases（93.3%）had low birth weight.Risk factors included use of broadspectrum antibiotics（29,96.7%）,tracheal intubation（18,60.0%）and central vein catheterization（14,46.7%）.Clinical manifestations included fever,apnea and shortness of breath.Compared with premature bacterial sepsis cases,there were fewer cases with elevated procalcitonin（PCT）and more cases with thrombocytopenia in neonates with fungal sepsis（both P〈0.01）.G test showed that 8 out of 9 cases had positive results（88.9%）.The pathogens were all Candida,including 19 strains of Candida albicans（63.3%）and 11 strains of non-Candida albicans（36.7%）.For Candida albicans,all strains were susceptible to amphotericin,14 strains were susceptible to fluconazole,while 3 strains were resistant to fluconazole and 2 strains were intermediate.All non-Candida albicans were susceptible to tested drugs.Totally 25 cases（83.3%）were cured after treatment.Conclusions The clinical manifestations of neonatal fungal sepsis were nonspecific.G test,PCT and platelet count were helpful for the diagnosis.Candida albicans were main pathogens in this study with some drug-resistant strains.Proper drug should be selected with the guidance of drug sensitive test.