希木龙假丝酵母感染相关性低出生体质量儿真菌血症的临床特点

Clinical characteristics of low birth weight infants with Candida haemulonii infection-associated fungemia

目的分析希木龙假丝酵母(Candida haemulonii)感染相关性低出生体质量儿真菌血症的临床病例特点,以提高临床对该病的诊断和治疗水平。方法选取2015年1月-2018年9月福建省妇幼保健院12例希木龙假丝酵母致真菌血症的低出生体质量儿为研究对象,回顾性分析患儿出生体质量、胎龄、临床表现等一般资料,侵入性操作、抗菌药物治疗和转归情况。结果共检出16株希木龙假丝酵母,菌株来源于12例患儿血液及其外周中心静脉置管(peripherally inserted central catheter,PICC)导管尖端。12例患儿均是低出生体质量的早产儿,平均住院天数均超过35 d,均行PICC,均使用广谱抗菌药物。实验室检查:12例希木龙假丝酵母真菌血症患儿白细胞计数基本正常或降低,10例血小板降低,9例C-反应蛋白增高,7例G试验结果增高。血液分离的12例希木龙假丝酵母对两性霉素B的耐药率较高,氟康唑虽未发现耐药菌株,但是50.0%的菌株MIC增高到8 mg/L,对5-氟胞嘧啶、伏立康唑、伊曲康唑的MIC值均较低。12例患儿均使用氟康唑治疗,9例治愈, 3例患儿治疗病情好转后家属因经济、家庭等因素自动出院。结论低出生体质量儿希木龙假丝酵母感染可能与外周中心静脉置管和广谱抗菌药物的使用具有相关性,结合这些因素和实验室检查对疾病早诊断,早治疗,采取隔离措施以防暴发流行。应用氟康唑治疗具有较好疗效。

OBJECTIVE To observe the clinical characteristics of low birth weight infants with Candida haemulonii infection-associated fungemia caused by so as to raise the level of clinical diagnosis and treatment of the disease. METHODS A total of 12 low birth weight infants with C. haemulonii-induced fungemia who were treated in Fujian Provincial Maternity and Children′s Hospital from Jan 2015 to Sep 2018 were recruited as the study objects.The baseline data of the infants, including the birth weight, gestational age and clinical manifestations as well as invasive procedures, antibiotic therapy and treatment outcomes were retrospectively analyzed. RESULTS Totally 16 strains of C. haemulonii were isolated from the blood specimens and tips of peripherally inserted central catheter(PICC) of the infants.All of the 12 infants were premature infants with low birth weight, with the average length of hospital stay more than 35 days, all of them received PICC and were treated with broad-spectrum antibiotics.The result of laboratory test showed that the white blood cells counts of the 12 infants with C. haemulonii fungemia were basically normal or reduced, the blood platelet counts of 10 infants were reduced, the C-reactive protein level of 9 infants was elevated, and the G test of 7 infants was elevated.The 12 strains of C. haemulonii that were isolated from the blood specimens were highly resistant to amphotericin B, the fluconazole-resistant strains were not found, the MIC against 50.0% of the strains was increased to 8 mg/L, while the MICs of itraconazole, voriconazole and 5-flucytosine were low. Of the 12 infants who treated with fluconazole, 9 were cured, and 3 were improved and automatically discharged due to economic and family factors. CONCLUSION The C. haemulonii infection in the low birth weight infants may be associated with the PICC and use of broad-spectrum antibiotics, the laboratory test combined with the above factors may contribute to the early diagnosis and treatment of the disease so as to take isolation measures for prevention of outbreak. Fluconazole can achieve remarkable curative effect.