新生儿侵袭性真菌感染的危险因素及病原学分析  

Analysis of Risk Factors and Pathogens for Invasive Fungal Infection in Neonates

作　　者：陈彩英 邓春[2] 龚放[1] Chen Caiying;Deng Chun;Gong Fang(Yongchuan Hospital of Chongqing Medical University,Chongqing 402160,China;Children’s Hospital of Chongqing Medical University,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属永川医院,重庆402160 [2]重庆医科大学附属儿童医院,重庆400014

出　　处：《儿科药学杂志》2021年第1期24-27,共4页Journal of Pediatric Pharmacy

摘　　要：目的:探讨新生儿侵袭性真菌感染(IFI)的危险因素及病原学特征。方法:采用回顾性病例对照研究方法,纳入重庆医科大学附属儿童医院新生儿重症监护病房2013-2017年确诊为IFI的56例住院患儿为病例组,根据胎龄、出院时间等,纳入168例非IFI患儿为对照组,收集病例资料,分析新生儿IFI的发病危险因素及病原学特征。结果:新生儿IFI的危险因素为:低球蛋白、需静脉注射丙种球蛋白、低白蛋白、低红细胞、低血小板、需输注血浆、合并败血症、使用抗生素种类多、静脉营养持续时间长、经外周静脉穿刺中心静脉置管(PICC)、留置PICC总时间长、支气管肺发育不良(BPD)、新生儿坏死性小肠结肠炎(NEC),进一步行二元Logistic回归分析发现,需静脉注射丙种球蛋白(OR:4.189,95%CI:1.527~11.489,P=0.044)、合并败血症(OR:3.719,95%CI:1.035~13.367,P=0.005)、使用抗生素种类多(OR:2.779,95%CI:1.537~5.025,P=0.001)、静脉营养持续时间长(OR:1.039,95%CI:1.003~1.075,P=0.034)为新生儿IFI的独立危险因素。病原菌主要为白色假丝酵母菌(51.61%)、近平滑假丝酵母菌(22.58%)。结论:临床怀疑新生儿IFI而病原学检查困难时,若新生儿存在需静脉注射丙种球蛋白、合并败血症、使用抗生素种类多、静脉营养持续时间长等高危因素,应根据病原菌分布特征,尽早经验性抗真菌治疗。Objective:To probe into the risk factors and pathogenic characteristics for invasive fungal infection(IFI)in neonates.Methods:Retrospective case-control study method was used,a total of 56 neonates diagnosed with IFI in the neonatal intensive care unit of Children’s Hospital of Chongqing Medical University from 2013 to 2017 were included in the case group.According to gestational age and discharge time,168 children with non-IFI were included in the control group.Clinical data were collected,the risk factors and pathogenic characteristics of IFI were analyzed.Results:The risk factors for neonatal IFI were as follows:low globulin,intravenous immunoglobulin,low albumin,low red blood cells,low platelets,infusing plasma,combined with sepsis,application of various kinds of antibiotics,long duration of intravenous nutrition,peripherally inserted central venous catheters(PICC),total time of indwelling PICC,bronchopulmonary dysplasia(BPD)and neonatal necrotizing enterocolitis(NEC).Further binary Logistic regression analysis showed that intravenous immunoglobulin(OR:4.189,95%CI:from 1.527 to 11.489,P=0.044),combined with sepsis(OR:3.719,95%CI:from 1.035 to 13.367,P=0.005),application of various kinds of antibiotics(OR:2.779,95%CI:from 1.537 to 5.025,P=0.001)and long duration of intravenous nutrition(OR:1.039,95%CI:from 1.003 to 1.075,P=0.034)were independent risk factors for neonatal IFI.The pathogens were mainly Candida albicans(51.61%)and Candida parapsilosis(22.58%).Conclusion:When IFI is suspected clinically and etiological examination is difficult for neonates,if there are high-risk factors such as intravenous immunoglobulin,combined with sepsis,application of various kinds of antibiotics,long duration of intravenous nutrition,empirical antifungal therapy should be given as soon as possible according to the distribution characteristics of pathogens.

关 键 词：新生儿 侵袭性真菌感染 危险因素 病原学 重症监护病房 

分 类 号：R722.1[医药卫生—儿科]