中国实用儿科杂志

中国实用儿科杂志

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儿科重症监护病房院内侵袭性真菌血流感染21例临床分析

  

  1. 中国医科大学附属盛京医院小儿急诊急救内科，辽宁  沈阳  110004
  • 出版日期:2019-06-06 发布日期:2019-07-04

Clinical research of nosocomial invasive fungal bloodstream infections in PICU children：A clinical analysis of 21 cases

  1. Department of PICU，Shengjing Hospital of China Medical University，Shenyang  110004，China
  • Online:2019-06-06 Published:2019-07-04

摘要：

目的    提高对侵袭性真菌感染（invasive fungal infection，IFI）的认识，帮助早期诊断、早期治疗，积极改善预后。方法　选取2012年1月至2018年1月于中国医科大学附属盛京医院儿科重症监护病房（PICU）住院，临床诊断IFI血流感染的21例患儿为研究对象，回顾性分析其临床特点、高危因素及预后。结果　临床诊断IFI血流感染的21例患儿中，真菌感染的发生与年龄性别无明显相关性，致病菌以白色念珠菌及近平滑假丝酵母菌为主，近平滑假丝酵母菌病死率较高（80%）；21例真菌血流感染的患儿，28 d随访存活8例，死亡13例，病死率高达61.90%；原发病以呼吸系统（14.29%）、消化系统疾病（23.81%）居多，其中重症肺炎4例，消化道穿孔4例；高危因素主要以广谱抗生素联合应用、侵入性操作（气管插管、中心静脉置管、导尿及留置胃管等）、长期ICU住院等为著，均在85%以上。真菌感染多表现为不典型发热（80.95%），白细胞异常升高或降低（47.62%），C反应蛋白多升高（80.95%），G试验的阳性率可达到42.86%；存活组的8例患儿诊断真菌感染前75%预防性应用抗真菌治疗，死亡组预防用药率为53.85%。结论　长期ICU住院、大量广谱抗生素的长期及联合应用、侵入性操作、自身免疫缺陷等因素的存在增加了真菌感染的风险，对于临床原发病基础上出现不典型难治感染，要警惕真菌感染，应积极完善相关微生物学检查。

关键词: 侵袭性真菌感染, 念珠菌, 高危因素, 临床分析

Abstract:

Objective　To improve the understanding of the IFI，and to help the early diagnosis and treatment and positive improvement of prognosis. Methods　A total of 21 children were chosen as the research subjects，who were diagnosed with the IFI bloodstream infection and were hospitalized in Shengjing Hospital affiliated to China Medical University from January 2012 to January 2018，and the clinical characteristics，high risk factors and prognosis of them were retrospectively analyzed. Results　There was no significant correlation between the incidence of fungal infection and age or sex in 21 children with IFI bloodstream infection. Candida albicans and Candida parapsilosis were the leading pathogen，and the mortality rate of Candida parapsilosis was high（80%）.For the 21 children with IFI bloodstream infection，the mortality rate was as high as 61.9%（13 cases） with 28 days’ following research. The protopathy was mainly respiratory system disease（14.29%） and digestive system disease（23.81%）. Among them，there were 4 cases of severe pneumonia and 4 cases of gastrointestinal perforation. The high risk factors were mainly the combined use of broad-spectrum antibiotics，invasive operation（tracheal intubation，central venous catheterization，catheterization and indwelling stomach tube，etc.），long-term hospitalization in ICU and so on，all above 85%. Fungal infection was characterized by atypical fever（80.95%），abnormal increase or decrease of white blood cells（47.62%） and CRP increase（80.95%）；the positive rate of G test could reach 42.86%. In the survival group including 8 cases of children，75% were treated with antifungal treatment before diagnosed with fungal infection；the rate of preventive drug use was 53.85% for the death group. Conclusion　Long-term hospitalization in ICU，long-term and combined use of a large amount of broad-spectrum antibiotics，invasive operation，autoimmune deficiency and other factors increase the risk of fungal infection. If there is atypical refractory infection after clinical primary diseases，fungal infection should be paid attention to and the related microbiological examination should be performed.

Key words: invasive fungal infection, candida, high risk factors, clinical analysis