中国实用儿科杂志

中国实用儿科杂志 ›› 2023, Vol. 38 ›› Issue (12): 932-936.DOI: 10.19538/j.ek2023120612

• 论著 • 上一篇    下一篇

儿科重症监护病房非血液肿瘤疾病患儿侵袭性真菌 感染临床研究

  

  1. 1. 郑州大学附属儿童医院  河南省儿童医院  郑州儿童医院PICU，河南  郑州  450018；2. 复旦大学附属儿科医院重症医学科，上海  201102
  • 出版日期:2023-12-06 发布日期:2023-12-13
  • 通讯作者: 成怡冰，电子信箱：13703829317@163.com；陆国平，电子信箱：13788904150@163.com
  • 基金资助:
    国家重点研发计划（2021YFC2701800，2021YFC2701805）

Clinical study on invasive fungal infection in children with non-hematologic tumor disease in PICU

  1. *Children's Hospital Affiliated to Zhengzhou University；Henan Children's Hospital；Zhengzhou Children's Hospital PICU，Zhengzhou  450018，China
  • Online:2023-12-06 Published:2023-12-13

摘要： 目的    总结儿科重症监护病房（PICU）非血液肿瘤疾病患儿不同类型侵袭性真菌感染（invasive fungal infection，IFI）的临床特征。方法    回顾性分析2017年1月至2022年12月在河南省儿童医院PICU住院的非血液肿瘤疾病IFI患儿的临床资料。结果    标本真菌结果阳性共267例，其中确诊IFI 59例。其中非血液肿瘤疾病58例，男35例，女23例，平均年龄（4.11±4.09）岁。IFI合并各系统慢性基础疾病28例。IFI常见危险因素包括应用广谱抗生素（100.00%）、留置各种导管（98.28%）、应用糖皮质激素（41.38%）、营养不良（20.69%）。58例IFI患儿中念珠菌感染31例（53.45%），曲霉菌12例（20.69%），呼吸道感染53例（91.38%）。IFI同期检出单纯病毒5例、单纯细菌23例、混合病原30例。对侵袭性念珠菌感染（ICI）组和侵袭性曲霉菌感染（IPA） 组患儿进行比较，免疫球蛋白M（IgM）水平差异存在统计学意义（P<0.05）。ICI和IPA患儿营养不良和粒细胞缺乏等危险因素差异均有统计学意义（均P<0.05）。结论    IFI在PICU并不少见，且预后差。念珠菌和曲霉菌仍是PICU中IFI的主要致病菌，呼吸道是最常见的IFI感染部位。IFI常合并其他病原菌感染，存在营养不良和IgM降低的患儿发生ICI概率可能更高，应及早识别并经验性使用抗真菌药物。中性粒细胞缺乏患儿更易合并IPA，该类患儿临床启动早期经验性治疗时要覆盖曲霉菌。

关键词: 儿科重症监护病房, 侵袭性真菌感染, 危险因素, 儿童

Abstract: Objective    To summarize the clinical characteristics of different types of invasive fungal infection （IFI） in children with non-hematologic tumor disease in PICU. Methods    Clinical data of children with non-hematologic neoplastic disease IFI hospitalized in PICU of Henan Children’s Hospital from January 2017 to December 2022 were retrospectively analyzed. Results    There were 267 cases of positive results of fungus in the samples，and a total of 59 children were diagnosed with IFI， including 58 children with non-hematologic neoplasm diseases， 35 males and 23 females， with an average age of （4.11±4.09） years. There were 28 cases of chronic underlying diseases associated with IFI. The most common risk factors for IFI were the use of broad-spectrum antibiotics （100.00%）， the indwelling of various catheters （98.28%）， the use of corticosteroids （41.38%） and malnutrition （20.69%）. Among the 58 children with IFI， 31 cases were Candida infection（53.45%）， 12 cases were Aspergillus infection （20.69%）， and 53 cases were respiratory tract infections （91.38%）. With IFI there were 5 cases of simple virus， 23 cases of simple bacteria and 30 cases of mixed pathogens during the same period. The comparison between children with invasive Candida infection（ICI） and those with invasive Aspergillus infection（IPA）showed that the difference in IgM level was statistically significant（P<0.05）. The difference in risk factors such as malnutrition and granulocyte deficiency between ICI and IPA children were statistically significant （all P< 0.05）. Conclusion    IFI is common in PICU and has a poor prognosis. Candida and Aspergillus are still the main pathogens of invasive fungal infection in PICU， and respiratory tract is the most common site of IFI infection. IFI is often associated with other pathogenic infections， and children with malnutrition and decreased IgM may have a higher probability of ICI， so it should be identified early and antifungal drugs should be empirically used. Children with neutrophil deficiency are more likely to be combined with IPA， and Aspergillus should be covered during early clinical initiation of empirical therapy for these children.

Key words: peditric intensive care unit, invasive fungal infection, risk factors, child