伏立康唑在儿童重症监护室治疗侵袭性真菌感染的有效性研究

Efficacy of Voriconazole in the Treatment of Invasive Fungal Infection in Pediatric Intensive Care Unit

目的:探讨伏立康唑在儿童重症监护室(PICU)治疗侵袭性真菌感染的临床疗效。方法:收集2019年9月至2020年5月住院期间使用伏立康唑进行真菌感染治疗的PICU患儿25例,分析患儿的用药目的、宿主因素、影像学表现、微生物检查以及治疗效果。结果:伏立康唑在PICU治疗侵袭性真菌感染的总有效率为52.0%,临床诊断治疗比拟诊治疗的用药疗程长且差异有统计学意义。患儿合并细菌感染、性别、诊断级别(拟诊和临床诊断)和年龄(<2岁和≥2岁)对伏立康唑的有效性比较差异均无统计学意义。伏立康唑治疗曲霉菌有效率为85.7%,治疗念珠菌有效率为28.6%,差异有统计学意义。结论:伏立康唑治疗侵袭性真菌感染有效率较低的原因可能与PICU患儿基础疾病复杂,导致抗真菌治疗无法得到有效控制有关。伏立康唑对侵袭性曲霉菌病治疗效果显著,对念珠菌效果较差。是否合并细菌感染、性别、诊断级别和年龄不影响伏立康唑的有效性。

Objective:To probe into the clinical efficacy of voriconazole in the treatment of invasive fungal infection in children in pediatric intensive care unit(PICU).Methods:Twenty-five children from PICU who were treated with voriconazole for fungal infection during hospitalization from Sept.2019 to May 2020 were extracted to analyze the purpose of medication,host factors,imaging manifestations,microbial examination and therapeutic effects.Results:The total effective rate of voriconazole in the treatment of invasive fungal infection in PICU was 52.0%.Clinical diagnosis had longer treatment course than proposed diagnosis and the difference was statistically significant.There were no statistically significant difference in the efficacy of voriconazole for children with co-infection,gender,diagnostic level(proposed and clinical diagnosis)and age(<2 and≥2 years old).The effective rate of voriconazole was 85.7%for Aspergillus and 28.6%for Candida,the difference was statistically significant.Conclusion:The reason for the low effective rate of voriconazole in the treatment of invasive fungal infection may be related to the complicated underlying diseases of children from PICU,leading to the ineffective control of antifungal therapy.Voriconazole has significant effect on invasive Aspergillosis,but poor effect on Candida.The presence or absence of co-infection,gender,diagnostic level and age do not affect the efficacy of voriconazole.