外科重症新生儿侵袭性真菌感染的回顾分析

Retrospective analysis of invasive fungal infection in severe surgical neonates

目的:探讨外科重症新生儿侵袭性真菌感染(invasive fungal infection, IFI)的高危因素及病原学分布,为建立外科新生儿重症监护病房(surgical neonatal intensive care unit, SNICU)患儿临床防治侵袭性真菌感染方案提供参考。方法:回顾广州市妇女儿童医疗中心SNICU 2016年1月1日至2019年12月31日确诊为IFI的所有病例,根据出院时间、胎龄等,按照1∶2的比例设立对照组,收集患儿病历资料,应用SPSS 25.0软件进行统计。结果:SNICU病区IFI发生率约为1%。单因素分析发现外科重症新生儿IFI的危险因素为住院时间>40 d、气管插管>1 d、留置尿管>1 d、静脉营养>19 d、使用2种以上抗生素、使用硝基咪唑类抗生素、使用碳青霉烯类抗生素、使用第3代头孢菌素、使用头孢哌酮钠舒巴坦钠、细菌感染(P<0.05);二元Logistic回归分析发现,使用第3代头孢菌素(OR:51.179,95%CI:2.361~1 109.256,P=0.012)、或使用头孢哌酮钠舒巴坦钠(OR:8.065,95%CI:1.113~58.468,P=0.039)为外科重症新生儿IFI的高危因素。该人群IFI的主要致病菌为高里假丝酵母菌(28.0%)与近平滑假丝酵母菌(28.0%),其次为白假丝酵母菌(24.0%)。结论:第3代头孢菌素和头孢哌酮钠舒巴坦钠的使用为SNICU病区IFI的独立危险因素,若患儿出现临床症状且存在以上高危因素时需警惕真菌感染,可予氟康唑经验性治疗。

OBJECTIVE To explore the high risk factors and pathogenic distribution of invasive fungal infection(IFI) in severe surgical neonates to establish a clinical prevention and treatment protocol for children in surgical neonatal intensive care unit(SNICU) for references.METHODS All cases of IFI diagnosed by SNICU were reviewed from January 1, 2016 to December 31, 2019. According to the time of discharge, gestational age, etc., control group was established at a ratio of 1∶2. The relevant medical records were collected and SPSS 25.0 software was utilized for statistics.RESULTS The incidence of IFI in SNICU was around 1%. Univariate analysis revealed that the risk factors of IFI in severe surgical neonates included hospitalization time >40 days, tracheal intubation >1 day, indwelling urinary catheter >1 day, intravenous nutrition >19 days, using >2 antibiotics, using nitroimidazole, using carbapenem, using third-generation cephalosporins, using cefoperazone sodium & sulbactam sodium and bacterial infections(P<0.05);binary Logistic regression analysis indicated that using third-generation cephalosporins(OR:51.179, 95% Cl:2.361-1 109.256, P=0.012) or cefoperazone sodium & sulbactam sodium(OR: 8.063, 95% Cl:1.113-58.468, P=0.039) was a high risk factor of IFI. The major pathogens of IFI in this population were Candida gaurii(28.0%), Candida parapsilosis(28.0%) and Candida albicans(24.0%).CONCLUSION Using third-generation cephalosporins or cefoperazone sodium & sulbactam sodium is an independent risk factor of IFI in SNICU. Onsets of clinical symptoms and the above high risk factors should raise a high alert for fungal infections. And empirical treatment of fluconazole may be offered.