不同年龄住院患者真菌菌血症的调查与分析  

Analysis on Fungemia in Different-Age Inpatients

作　　者：艾冬云[1] 赖晓全[1] 陈金敏[1] 于孟[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院医院感染科,武汉430030

出　　处：《华中科技大学学报（医学版）》2012年第1期106-109,共4页Acta Medicinae Universitatis Scientiae et Technologiae Huazhong

基　　金：湖北省自然科学基金资助项目(No.2009CDB240)

摘　　要：目的研究不同年龄段住院患者真菌菌血症流行病学特征、菌种分布及药敏谱、临床治疗及转归的差别,为有效治疗和预防提供科学依据。方法回顾分析和比较武汉同济医院2008年1月至2010年12月住院不同年龄段真菌菌血症患者的临床资料和实验室检查结果。结果 3年间共发现1 104例住院真菌菌血症病例,其中新生儿69例,儿童72例,成人963例,发病率分别为新生儿1.93%、儿童0.45%、成人0.41%;主要的危险因素:新生儿为早产、低出生体重及静脉内营养,儿童为白血病、中性粒细胞减少症及入住ICU≥4d,成人为糖尿病、泌尿系统疾病、血液透析、恶性肿瘤、使用碳青霉烯类抗菌药物;引起真菌菌血症的菌株中48.01%为白假丝酵母菌,近平滑假丝酵母菌在新生儿和儿童更多见(新生儿占44.9%、儿童占38.9%、成人占15.1%),而光滑假丝酵母菌则在成人更多见(新生儿占8.8%、儿童占2.8%、成人占20.1%);儿童真菌菌血症分离菌株对氟康唑的敏感性显著高于成人,所有菌株对氟康唑的耐药率均较低;所有病例以氟康唑治疗为主;发生真菌菌血症后30d内病死率分别为:新生儿21.8%、儿童9.9%、成人29.3%。结论不同年龄段住院患者真菌菌血症流行病学及临床特征存在显著的差异,新生儿科及儿科医生在制订治疗和预防方案时应考虑年龄差异。Objective To identify differences in incidence,risk factors,microbiology and clinical outcome of fungemia in neonates,children and adults,and to provide evidence for prevention and therapy.Methods The clinical data and blood culture surveillance of fungemia were analyzed and compared retrospectively from Jan.2008 to Dec.2010 in Tongji Hospital in Wuhan.Results A total of 1 104 cases of fungemia were reported：69 neonates,72 children,and 963 adults.The incidence in neonates,children and adults was 1.93%,0.45% and 0.41%,respectively.Prematurity,lower birth weight and hyperalimentation were major risk factors in neonates.Hematologic malignancy,neutropenia and ICU admission ≥4 days were major risk factors in children.And diabetes,urological comorbidities,malignancy,surgery and administration of carbopenems were major risk factors in adults.Candida albicans caused 48.01% of cases in all of the age groups.Candida parapsilosis was significantly more common in neonates and children than in adults（44.9% and 38.9% vs 15.1%）.Candida glabrata was significantly more common in adults than in neonates and children（20.1% vs 8.8% and 2.8%）.Significantly more isolates from children were susceptible to fluconazole than those from adults.Fluconazole-resistant candidal isolates were infrequent in all of the age groups.All cases were more likely to receive fluconazole.The crude mortality at 30 days was 21.8%,9.9% and 29.3% in neonates,children and adults,respectively.Conclusion There is significant difference in epidemiological and clinical characteristics in fungemia in neonates,children and adults.Neonatologists and pediatricians must consider age-specific differences when interpreting adult studies and developing treatment and prevention guidelines.

关 键 词：真菌菌血症 真菌感染 医院感染 

分 类 号：R519[医药卫生—内科学]