摘要
目的分析新生儿希木龙假丝酵母菌真菌血症的临床特征及同源性,以提高对该病的诊断和治疗水平,为该菌感染防控提供依据。方法对2014年5—10月间温州医科大学附属第二医院新生儿科15例希木龙假丝酵母菌败血症患儿的临床和病原学资料进行回顾性分析。对分离菌株由Vitek2-Compact鉴定和18S rRNA序列测定,用随机扩增多态性DNA(RAPD)进行同源性分析;同时根据医院感染流行病学特征,对患儿周围环境、物品、器材及医护人员的手等进行采样培养。结果 15例患儿发生希木龙假丝酵母菌血流感染的时间为住院后12~39 d,平均23 d;均接受中心静脉置管(PICC)。8例经伏立康唑治疗15~30 d痊愈,5例使用氟康唑20~30 d治愈,2例家属要求放弃治疗。菌株经仪器鉴定和18S rRNA序列测定确认为希木龙假丝酵母菌。RAPD分型结果显示13株菌株均为同一克隆株。从环境、物品、器械及医护人员的手等处采集的标本均未培养出希木龙假丝酵母菌,但采取积极的医院感染控制措施后未再出现类似病例。结论希木龙假丝酵母菌可在住院患儿间进行水平传播,引起新生儿院内交叉感染;PICC是引起新生儿希木龙假丝酵母菌医院感染的独立危险因素;落实院内感染防控措施是关键。
Objective To investigate the clinical features of fungemia among neonates caused by Candida haemulonii,perform the homological analysis of the strains,provide guidance for prevention of the C. heamulonii infection,and improve the diagnosis and treatment level. Methods The clinical data of 15 infants with Candida haemulonii was retrospectively analyzed from May to October in 2014. The isolates were identified by standard laboratory procedures,including the use of Vitek2-Compact YST card systems and sequence analysis of 18 S rRNA. Homological analysis was performed by using random amplified polymorphic DNA assay to explore the epidemiological characteristics of this nosocomial infection. According to hospital infection epidemiological characteristics,the samples were isolated from the surrounding environment,object surface,equipment and the hands of medical staff. Results All the patients were in the NICU for 12- 39 days before they developed fungemia due to C. haemulonii. All infected neonatal had received central venous catheter. Five infants were healed after a therapy of fluconazole for 20- 30 days. After 15- 20 days of voriconazole treatment,the other eight cases recovered well and subsequent blood cultures were negative for yeasts. Two cases were given up. The isolates were identified and confirmed as C. haemulonii. RAPD genotyping results showed that all strains were from the same clone. C.heamulonii were not detected in the samples from the surrounding environment,object surface,equipment and the hands of medical staff. No similar casesoccurred after positive control measures despite a negative epidemiological sampling. Conclusion C. haemulonii may transmit horizontally among the hospitalization neonates,causing neonatal hospital infections.PICC is the independent risk factor of causing neonatal hospital infections. It is necessary to take comprehensive prevention measures to cut off the transmission route.
出处
《中华全科医学》
2017年第2期318-320,330,共4页
Chinese Journal of General Practice
