摘要
目的分析新生儿重症监护病房侵袭性深部真菌感染(invasive fungal infections,IFI)的临床特点,为其防治提供参考。方法选择2009年1月至2014年12月解放军总医院第七医学中心八一儿童医院新生儿重症监护病房确诊的102例IFI患儿为研究对象,对其临床资料进行回顾性分析,总结患儿发病特点、临床表现、实验室检查、治疗及转归等。结果102例IFI患儿中男68例,女34例;早产儿75例(73.5%),胎龄(32.7±4.4)周,出生体重(1898±913)g。发病日龄为生后1~99 d,其中早发型9例(8.8%),晚发型93例(91.2%)。98例为血培养阳性,4例为血培养阴性但脑脊液培养阳性。分离出的103株真菌中,前3位分别为白色假丝酵母菌53株(51.5%)、近平滑假丝酵母菌26株(25.2%)、光滑假丝酵母菌9株(8.7%)。32例(31.4%)出现皮肤灰暗、灌注差等感染性休克表现。25例(24.5%)外周血中性粒细胞计数﹤1.0×109/L,68例(66.7%)血小板计数﹤100×109/L;真菌D葡聚糖检测平均值(853±623)ng/L。16例(15.7%)合并器官受累,其中11例合并真菌性脑膜炎,3例合并真菌性眼内炎,2例合并泌尿系感染。经氟康唑或伏立康唑治疗,84例(82.4%)治愈,10例(9.8%)病情好转后家属因担心后遗症或经济原因自动出院,8例(7.8%)死亡。结论早产儿和低出生体重儿是IFI主要群体,以白色假丝酵母菌为主,临床表现多样,易合并器官受累,不良预后率高,需要引起重视。
Objective To analyze the clinical features of invasive fungal infections(IFI)in NICU,and to provide reference for prevention and treatment of IFI.Methods From January 2009 to December 2014,102 cases with IFI in NICU,BaYi Children's Hospital,The Seventh Medical Center,General Hospital of PLA were investigated,whose clinical data were retrospectively analyzed,and the clinical features,clinical manifestations,laboratory examination,treatment and outcomes of the children were summarized.Results Total of 68 cases with IFI were male,34 cases were female;75 cases(73.5%)were preterm infants,with average gestational age(32.7±4.4)weeks and average birth weight(1898±913)g.The onset date of that was 1 to 99 days after birth,including 9 cases of early-onset(8.8%),93 cases of late-onset(91.2%).98 cases were positive blood cultures,4 cases were positive cerebrospinal fluid cultures with negative blood cultures.Among of 103 isolated fungi,the top three of that were Candida albicans in 53 cases(51.5%),Candida parapsilosis in 26 cases(25.2%)and Candida glabrata in 9 cases(8.7%).Thirty-two cases(31.4%)had septic shock symptoms with gray skin and poor perfusion.The neutrophil number of 25 cases(24.5%)in peripheral blood was﹤1.0×109/L and the thrombocytopenia number of 68 cases(66.7%)in peripheral blood was﹤100×109/L respectively.The average value of fungal dextran was(853±623)ng/L through detecting.A total of 16 cases(15.7%)were found with end organ involvement,including 11 cases of fungal meningitis,3 cases of fungal endophthalmitis,2 cases with urinary tract infection.Eighty-four cases were cured(82.4%),10 cases(9.8%)improved but discharged early because of worring about their outcome or economic reasons,8 cases died(7.8%)by the treatment of fluconazole or voriconazole.Conclusion Premature infants and low birth weight infants are the main group of IFI,mainly composed of Candida albicans,with various clinical manifestations and with end organ involvement easily,high rate of poor prognosis,which is necessary to pay attentio
作者
郑天
李秋平
陈海花
崔杰
唐洪怡
马倩倩
封志纯
ZHENG Tian;LI Qiu-ping;CHEN Hai-hua;CUI Jie;TANG Hong-yi;MA Qian-qian;FENG Zhi-chun(Neonatal Intensive Care Unit,BaYi Children's Hospital,The Seventh Medical Center,General Hospital of PLA,Beijing 100700,China;Department of Information,The Seventh Medical Center,General Hospital of PLA,Beijing 100700,China)
出处
《发育医学电子杂志》
2019年第4期292-296,共5页
Journal of Developmental Medicine (Electronic Version)
基金
国家自然科学基金(81671504)
