中国25家三级医院新生儿重症监护病房早产儿真菌败血症发生现状  

Status of fungal sepsis among preterm infants in 25 neonatal intensive care units of tertiary hospitals in China

作　　者：曹芯诚 蒋思远 李淑涓 韩俊彦 周琦 李萌萌[2] 白瑞苗 夏世文[4] 杨祖铭[5] 盖建芳[6] 张宝泉[7] 杨传忠[8] 袁静 潘丹丹 石静云[11] 胡雪峰[12] 林振浪[13] 王杨[14] 曾丽春[15] 朱艳萍[16] 韦秋芬[17] 郭艳[18] 陈玲[19] 刘翠青[20] 姜善雨[21] 李晓莺[22] 孙慧清[23] 齐宇洁[24] 黑明燕[25] 曹云 Cao Xincheng;Jiang Siyuan;Li Shujuan;Han Junyan;Zhou Qi;Li Mengmeng;Bai Ruimiao;Xia Shiwen;Yang Zuming;Ge Jianfang;Zhang Baoquan;Yang Chuanzhong;Yuan Jing;Pan Dandan;Shi Jingyun;Hu Xuefeng;Lin Zhenlang;Wang Yang;Zeng Lichun;Zhu Yanping;Wei Qiufen;Guo Yan;Chen Ling;Liu Cuiqing;Jiang Shanyu;Li Xiaoying;Sun Huiqing;Qi Yujie;Hei Mingyan;Cao Yun(Department of Neonatology,Children′s Hospital of Fudan University,National Children′s Medical Center,Shanghai 201102,China;Department of Neonatology,Women′s Hospital of Nanjing Medical University,Nanjing 210004,China;Department of Neonatology,Northwest Women′s and Children′s Hospital,Xi′an 200001,China;Department of Neonatology,Maternal and Child Hospital of Hubei Province,Wuhan 430064,China;Department of Neonatology,Suzhou Municipal Hospital,Suzhou 215008,China;Department of Neonatology,Shanxi Children′s Hospital,Taiyuan 030006,China;Department of Neonatology,Fujian Maternity and Child Health Hospital,Fuzhou 350005,China;Department of Neonatology,the Affiliated Shenzhen Maternity and Child Healthcare Hospital of Southern Medical University,Shenzhen 518047,China;Department of Neonatology,Qingdao Women and Children′s Hospital,Qingdao 266011,China;Department of Neonatology,Guiyang Maternal and Child Health Care Hospital,Guiyang Children′s Hospital,Guiyang 550002,China;Department of Neonatology,Gansu Provincial Maternity and Child-care Hospital,Lanzhou 730050,China;Department of Neonatology,Shanghai First Maternal and Infant Hospital,Shanghai 201204,China;Department of Neonatology,the Second Affiliated Hospital and Yuying Children′s Hospital of Wenzhou Medical University,Wenzhou 325088,China;Department of Neonatology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,China;Department of Neonatology,Jiangxi Provincial Children′s Hospital,Nanchang 330006,China;Department of Neonatology,the First Affiliated Hospital of Xinjiang Medical University,Urumchi 830054,China;Department of Neonatology,Maternity and Child Health Care of Guangxi Zhuang

机构地区：[1]国家儿童医学中心复旦大学附属儿科医院新生儿科,上海201102 [2]南京医科大学附属妇产医院新生儿科,南京210004 [3]西北妇女儿童医院新生儿科,西安200001 [4]湖北省妇幼保健院新生儿科,武汉430064 [5]苏州市立医院新生儿科,苏州215008 [6]山西省儿童医院新生儿科,太原030006 [7]福建省妇幼保健院新生儿科,福州350005 [8]南方医科大学附属深圳市妇幼保健院新生儿科,深圳518047 [9]青岛市妇女儿童医院新生儿科,青岛266011 [10]贵阳市妇幼保健院贵阳市儿童医院新生儿科,贵阳550002 [11]甘肃省妇幼保健院新生儿科,兰州730050 [12]上海市第一妇婴保健院新生儿科,上海201204 [13]温州医科大学附属第二医院育英儿童医院新生儿科,温州325088 [14]安徽医科大学第一附属医院新生儿科,合肥230022 [15]江西省儿童医院新生儿科,南昌330006 [16]新疆医科大学附属第一医院新生儿科,乌鲁木齐830054 [17]广西壮族自治区妇幼保健院新生儿科,南宁530002 [18]南京医科大学附属儿童医院新生儿科,南京210008 [19]华中科技大学同济医学院附属同济医院新生儿科,武汉430014 [20]河北省儿童医院新生儿科,石家庄050031 [21]无锡市妇幼保健院新生儿科,无锡214002 [22]山东大学附属儿童医院济南市儿童医院新生儿科,济南250022 [23]郑州大学附属儿童医院河南省儿童医院郑州儿童医院新生儿科,郑州450018 [24]首都医科大学附属北京儿童医院新生儿科,北京100045 [25]中南大学湘雅三医院新生儿科,长沙410013

出　　处：《中华儿科杂志》2023年第1期29-35,共7页Chinese Journal of Pediatrics

基　　金：美国中华医学基金会(14-194)。

摘　　要：目的分析中国25家新生儿重症监护病房(NICU)中早产儿真菌败血症的发生现状和危险因素, 为探讨真菌败血症预防策略提供依据。方法对"基于证据的质量改进方法降低中国新生儿重症监护病房院内感染发生率的整群随机对照试验"建立的早产儿临床数据库资料进行二次分析, 回顾性分析2015年5月至2018年4月生后7 d内收入中国25家三级医院NICU的24 731例早产儿的真菌败血症发生现况。根据早产儿是否发生真菌败血症分为真菌败血症组和未发生真菌败血症组, 分析真菌败血症的发生率和病原。使用χ^(2)检验比较不同出生胎龄、不同出生体重和不同NICU早产儿真菌败血症发生率。使用多因素Logistic回归分析方法比较真菌败血症组和未发生真菌败血症组早产儿预后。通过倾向性评分匹配144例真菌败血症组早产儿和288例无真菌败血症组早产儿, 使用单因素和多因素Logistic回归分析方法分析发生真菌败血症的危险因素。结果 24 731例早产儿中166例(0.7%)发生真菌败血症, 真菌败血症早产儿出生胎龄为(29.7±2.0)周, 出生体重为(1 300±293)g, 其中87.3%(145/166)为出生胎龄<32周的早产儿。出生胎龄和出生体重越低, 真菌败血症的发生率越高(均P<0.001)。极早产儿和超早产儿真菌败血症发生率分别为1.0%(117/11 438)和2.0%(28/1 401), 极低出生体重儿和超低出生体重儿中分别为1.3%(103/8 060)和1.7%(21/1 211)。3家NICU无真菌败血症发生, 其余22家NICU真菌败血症的发生率范围为0.7%(10/1 397)~2.9%(21/724), 差异有统计学意义(P<0.001)。166例早产儿真菌败血症病原菌主要为念珠菌150例(90.4%), 其中白色念珠菌有59例、非白念珠菌有91例, 非白念珠菌以近平滑假丝酵母菌(41例)为主。真菌败血症早产儿发生中重度支气管肺发育不良(调整OR=1.52, 95%CI 1.04~2.22, P=0.030)和严重早产儿视网膜病(调整OR=2.55, 95%CI 1.12~5.80, P=0.025)Objective To analyze the prevalence and the risk factors of fungal sepsis in 25 neonatal intensive care units(NICU)among preterm infants in China,and to provide a basis for preventive strategies of fungal sepsis.Methods This was a second-analysis of the data from the"reduction of infection in neonatal intensive care units using the evidence-based practice for improving quality"study.The current status of fungal sepsis of the 24731 preterm infants with the gestational age of<34+0 weeks,who were admitted to 25 participating NICU within 7 days of birth between May 2015 and April 2018 were retrospectively analyzed.These preterm infants were divided into the fungal sepsis group and the without fungal sepsis group according to whether they developed fungal sepsis to analyze the incidences and the microbiology of fungal sepsis.Chi-square test was used to compare the incidences of fungal sepsis in preterm infants with different gestational ages and birth weights and in different NICU.Multivariate Logistic regression analysis was used to study the outcomes of preterm infants with fungal sepsis,which were further compared with those of preterm infants without fungal sepsis.The 144 preterm infants in the fungal sepsis group were matched with 288 preterm infants in the non-fungal sepsis group by propensity score-matched method.Univariate and multivariate Logistic regression analysis were used to analyze the risk factors of fungal sepsis.Results In all,166(0.7%)of the 24731 preterm infants developed fungal sepsis,with the gestational age of(29.7±2.0)weeks and the birth weight of(1300±293)g.The incidence of fungal sepsis increased with decreasing gestational age and birth weight(both P<0.001).The preterm infants with gestational age of<32 weeks accounted for 87.3%(145/166).The incidence of fungal sepsis was 1.0%(117/11438)in very preterm infants and 2.0%(28/1401)in extremely preterm infants,and was 1.3%(103/8060)in very low birth weight infants and 1.7%(21/1211)in extremely low birth weight infants,respectively.There was no

关 键 词：重症监护病房 新生儿 婴儿 早产 真菌 

分 类 号：R722.6[医药卫生—儿科]