23例新生儿希木龙假丝酵母菌败血症临床分析

Clinical analysis of 23 cases of neonatal candida haemulonii sepsis

目的探讨新生儿希木龙假丝酵母菌败血症的临床表现、感染特点、危险因素、治疗效果及转归等情况。方法选择2014年1月～2016年12月我院收治的23例希木龙假丝酵母菌感染的新生儿的临床表现,血培养结果,菌株同源性分析,药敏结果及转归进行回顾性分析。结果 23例患儿平均出生胎龄为(32.5±4.5)周,平均出生体重(1772.8±867.7)g,平均发病日龄为(23.9±12.6)d。所有患儿均有经外周中心静脉置管和使用静脉营养,平均置管和静脉营养时间分别为(23.4±13.7)d和(38.0±14.3)d;感染前均有长时间使用抗生素,平均时间(10.7±4.6)d;18例患儿接受有创机械通气,平均时间为(9.7±12.0)d。其中有15例患儿集中发生在2014年5～10月。临床表现无特异性,多为发热、呼吸暂停、呕吐、腹胀。感染初期有血小板计数下降,C反应蛋白升高。23例血培养均为希木龙假丝酵母菌,13株菌株来源于同一克隆株,7例患儿表现出不同程度的耐药性,其中两性霉素B耐药2例,伊曲康唑耐药4例,氟康唑耐药4例。结论新生儿希木龙假丝酵母菌败血症临床表现无特异性,应加强早产儿护理,合理使用抗生素,严格掌握经外周中心静脉置管使用指征,尽早建立全胃肠道营养,在高发季节可以对高危早产儿口服抗真菌药物预防真菌感染,感染后应采取隔离措施以防爆发流行。

Objective To investigate the clinical manifestations,infection characteristics,risk factors,therapeutic effects and prognosis of neonatal Candida haemulonii sepsis.Methods Clinical manifestations,blood culture results,homology analysis,drug susceptibility results and outcomes of 23 neonates infected with Candida haemulonii were analyzed retrospectively observed in the Second Affiliated Hospital of Wenzhou Medical University and Yuying Children's Hospital from January 2014 to December 2016.Results The average gestational age of 23 children was(32.5±4.5)weeks;the average birth weight was(1772.8±867.7)g;and the average age of onset was(23.9±12.6)days.All patients had peripheral venous catheterization and intravenous nutrition.The average catheterization and venous nutrition time were(23.4±13.7)days and(38.0±14.3)days,respectively.Antibiotics were used for prolonged periods before infection,with the average time of(10.7±4.6)days.18 patients received invasive mechanical ventilation,with the average time of(9.7±12.0)days.Fifteen of these children were concentrated from May to October 2014.The clinical manifestations were not specific,mostly as fever,apnea,vomiting,abdominal distension.In the early stages of infection,platelet counts decreased and C-reactive protein increased.23 blood cultures were all candida haemulonii,and 13 strains were from the same clonal strain.7 patients showed different degrees of drug resistance.Among them,there were 2 cases of resistant to amphotericin B,4 cases of drug resistance to itraconazole and 4 cases of fluconazole resistance.Conclusion The clinical manifestations of neonatal Candida haemulonii sepsis are non-specific.It is necessary to strengthen the nursing of premature infants,rationally use antibiotics,strictly control the indications of peripheral central vein catheter insertion,and establish complete gastrointestinal nutrition as early as possible.In high season,oral antifungal drugs can be administered to high-risk preterm infants to prevent fungal infections,and isolation measures should be taken to prevent infections after infection.