76例新生儿侵袭性真菌感染回顾性分析：2004年至2014年  

Retrospective analysis of 76 neonates with invasive fungal infection in 2004-2014

作　　者：韩俊彦[1] 曹云[1] 蒋思远[1] 陈超[1] 周琦[1] 陈娜[1] 

机构地区：[1]复旦大学附属儿科医院新生儿科,上海201102

出　　处：《中华围产医学杂志》2016年第8期586-591,共6页Chinese Journal of Perinatal Medicine

基　　金：上海市科学技术委员会2013年医学引导项目（134119a0702）

摘　　要：目的回顾性分析新生儿侵袭性真菌感染（invasive fungal infection，IFI）的临床特征，以指导临床诊疗及预防。方法研究对象为2004年1月至2014年12月复旦大学附属儿科医院新生儿重症监护病房（neonatal intensive care unit，NICU）收治的76例IFI病例。对新生儿IFI的临床表现、真菌病原学、实验室检查、并发症、临床转归等进行描述性分析。结果2004年至2014年共76例IFI病例，病例数逐年增加。所有IFI病例中，早产儿68例（89．5％）；除1例出生体重不详外，余75例中出生体重〈1000g的早产儿11例（14．7％），出生体重≥1000～〈1500g的早产儿34例（45．3％），出生体重≥1500～〈2500g的早产儿20例（26．7％），出生体重≥2500g的患儿10例（13．3％）。病原菌主要为念珠菌[97．4％（74／76）]，其中白念珠菌有26例（34．2％），近年来，非白念珠菌比例呈上升趋势；季也蒙假丝酵母菌为最常见的非白念珠菌，占29．2％（14／48）。1例平滑念珠菌对氟康唑耐药，尚无白念珠菌对氟康唑耐药。发生真菌感染前的危险因素暴露包括：使用广谱抗生素（93．3％，56／60）、肠外营养（70．0％，42／60）、中心静脉置管（53．3％，32／60）、有创机械通气（40．0％，24／60）和感染前腹部手术史（21．7％，13／60）。主要临床表现为体温不稳定、频繁呼吸暂停、对呼吸支持需求增加、喂养不耐受等。76例中，6例确诊中枢神经系统真菌感染；进行头颅MRI检查患儿中，46.8％（22／47）可见脑实质内多发异常信号。共52例IFI者出院时真菌感染治愈，另有7例死产，其中1例死亡与真菌感染相关。结论NICU内IFI病例数逐年上升，主要见于早产儿。近年来非白念珠菌逐渐增多，成为主要的致病菌。新生儿IFI缺乏典型临床表现，应引起临床重视。感染前危险因素暴露主要为应用广谱抗生素、肠外营Objective To investigate the clinical features of neonatal invasive fungal infection（IFI） so as to guide diagnosis, prevention and treatment of IFI. Methods Seventy-six neonates with IFI admitted to the Neonatal Intensive Care Unit （NICU） at Children＇s Hospital of Fudan University from 2004 to 2014 were included in the study. Pathogens, clinical manifestation, risk factor exposure, laboratory findings, complications, and clinical outcome of neonatal IFI were analyzed. Results Seventy-six cases were diagnosed as IFI between 2004 and 2014, with an yearly increasing trend. Sixty eight patients were premature infants （89.5%）. Of the 76 cases, except one with unknown birth weight, 11（14.7%）, 34（45.3%）, 20（26.7%）and 10 （13.3%） cases had birth weight 〈 1 000 g, （≥1000 〈1 500） g, （ ≥ 1 500-〈2 500） g and ≥ 2 500 g, respectively. The pathogens were mainly Candida （74/76, 97.4%）, including 26 cases of Candida albicans （34.2%）. However, the incidence of non-Candida albicans infection was increasing. Candida guilliermondii was the most common in non- Candida albicans, accounting for 29.2% （14/48）. All Candida albicans were sensitive to fluconazole. One strain of Candida glabrata was resistant to fluconazole. The most common risk factors included use of broad-spectrum antibiotics（93.3%, 56/60）, parenteral nutrition（70.0%, 42/60）, central vein catheterization（53.3%, 32/60）, invasive ventilation（40.0%, 24/60） and history of abdominal surgery（21.7%,13/60）. Clinical manifestations of IFI included temperature instability, frequent apnea, increased requirement of respiratory support and feeding intolerance. Among all cases, six were diagnosed as central nervous system infection. Of the patients who received cranial MRI, 46.8%（22/47） showed multiple abnormal signals in cerebral parenchyma. Fifty- two patients were cured and seven patients died before discharge, including one death due to fungal infection. Conclusions There is an increasing trend of

关 键 词：念珠菌病 侵袭性 重症监护病房 新生儿 回顾性研究 

分 类 号：R722.13[医药卫生—儿科]