早产儿真菌性败血症暴发流行的控制  

Control of an outbreak of candidemia in premature infants

作　　者：张小兰[1] 朱小瑜[1] 梅家平[1] 杨勇[1] 连朝辉[1] 杨传忠[1] 石玉萍[1] 徐月玲[1] 熊小云[1] 

机构地区：[1]南方医科大学附属深圳妇幼保健院新生儿科,518028

出　　处：《中国新生儿科杂志》2011年第1期27-30,共4页Chinese Journal of Neonatology

摘　　要：目的总结我院新生儿重症监护病房(NICU)早产儿真菌性败血症暴发流行的防控救治经验。方法对2008年本科真菌性败血症暴发流行患儿的临床资料和防控措施进行回顾性分析。结果 (1)临床特点:16d内发生早产儿真菌性败血症11例,均为医院感染;极低出生体重儿8例,超低出生体重儿1例;主要症状为在原发病的基础上突然发热、肤色苍白、肢端发凉、皮肤花纹、心率减慢或增快、呼吸急促或呼吸暂停、发绀、腹胀、拒奶、反应差等,不能以原发病解释;实验室检查WBC明显降低或增高,中性粒细胞比例增高,CRP增高,PLT减少;胸部X线多出现新的病灶或原有表现加重;血培养热带假丝酵母菌阳性9例,胃液培养4例,阳性1例;本次传染源为一例院外感染患儿。(2)防控措施:隔离患儿,加强病室空气和物品消毒,切断一切可能的传播途径。(3)救治:氟康唑静脉给药,加强抗细菌、免疫支持疗法。(4)转归:流行历时16d,至最后1例血培养转阴历时23d,至最后1例出院历时100d,全部治愈出院。结论 NICU可流行真菌性败血症,多累及早产儿、极(超)低出生体重儿,多种标本培养有助于明确诊断。科学防控、有效的综合治疗能取得良好效果。加强消毒隔离、明确并切断传播途径是控制流行的关键。Objective To summarize the experience about emergency management,treatment and control of an outbreak of candidemia in premature infants in neonatal intensive care unit （NICU） in our hospital. Methods The clinical data of 11 premature infants with fungal sepsis and measures of control and prevention were analyzed retrospectively. Results （1） Clinical characteristics：From May 21 to Jun 5,2008,an outbreak of candidemia due to Candida tropicalis lasted for 16 days,which involved 11 infants,all of them were premature and most of them were very low birth weight infants （VLBWI） and extremely low birth weight infants （ELBWI）. The infections were hospital-acquired. The main manifestations were abrupt fever,pallor,mottling,cold,clammy skin,tachycardia or bradycardia,tachypnea or apnea,cyanosis,abdominal distention,poor feeding and lethargy,not explained by the previous diseases. Laboratory findings showed leukocytopenia obviously or leukocytosis,neutrophilia and high C-reactive protein,and thrombocytopenia in some cases. Mostly chest roentgenograms showed new or worse foci. Blood cultures of 9 infants were positive for Candida tropicalis,gastric aspirate culture was positive in one infant. The source of the infection was an infected infant from community. （2） Methods of control：isolation of the infected infants,disinfection of the ward＇s air and objects,interruption of all the possible pathways of transmission. （3）Treatment：antifungal therapy with intravenous fluconazole,antibacterial therapy and immunotherapy. （4） Outcome：the infection lasted for 16 days; blood culture from the last case turned to negative by day 23; the last infant was discharged from hospital by day 100. All infected infants recovered fully. Conclusions An outbreak of candidemia may occur in NICU,mostly involving premature,VLBWI and ELBWI. Culture of multiple samples from different source is useful in definite diagnosis. The scientific measures of control and prevention,the effective and comprehensive treatments,ca

关 键 词：真菌血症 氟康唑 婴儿 新生 医院感染 

分 类 号：R722.6[医药卫生—儿科]