新生儿重症监护病房中新生儿真菌败血症的临床特点

doi:10.3969/j.issn.1671-167X.2017.05.008

摘要/Abstract

摘要： 目的探讨新生儿真菌败血症的临床特点,并与新生儿细菌败血症的临床特点进行比较,提高对新生儿真菌败血症的认识。方法选取2011—2016年北京大学第一医院新生儿重症监护病房中收治的新生儿真菌败血症患儿的临床资料进行回顾性分析,同时选取同期住院的新生儿细菌败血症患儿,对两组患儿的临床特点进行比较。结果共纳入新生儿真菌败血症患儿15例,真菌败血症发生情况为0.52%,极低出生体重儿为2.5%。临床表现非特异,所有患儿应用肠外营养、广谱抗生素,13例患儿留置外周放置中心静脉导管(peripheral inserted central venous catheter,PICC)。病原学分析显示,光滑假丝酵母菌(Candida glabrata)占第一位,对二性霉素B均敏感,一株光滑假丝酵母菌对氟康唑耐药。与同期34例新生儿细菌败血症患儿比较,真菌败血症组的血小板计数明显低于细菌败血症组(61×10⁹/L vs. 178×10⁹/L, P=0.004),血小板下降比例明显高于细菌败血症组(80.0% vs. 29.4%, P=0.001),留置PICC比例高于细菌败血症组(86.7% vs. 55.7%, P=0.037)。受试者工作特征曲线(receiver operating characteristic curve,ROC曲线)分析发现,以血小板计数145×10⁹/L为界值时,预测新生儿真菌败血症的敏感度和特异度分别为61.8%和92.9%。经规范的抗真菌治疗后,真菌败血症患儿均治愈,血小板恢复正常,肝、肾功能未见明显变化。结论新生儿真菌败血症的临床表现呈非特异性,病原以光滑假丝酵母菌占第一位,给予规范治疗疗效较好,血小板降低和留置PICC可能提示真菌感染。

关键词: 脓毒症, 菌血症, 真菌血症, 婴儿, 新生, 念珠菌属

Abstract: Objective: To study the characteristics of neonatal fungal sepsis and the difference between bacterial sepsis and fungal sepsis. To improve the understanding of neonatal fungal sepsis. Methods: Clinical data of neonatal fungal sepsis in neonatal intensive care unit (NICU) were collected from 2011 to 2016 in Peking University first Hospital. The clinical characteristics were analyzed retrospectively. The difference between neonatal fungal sepsis and bacterial sepsis was also analyzed. Results: Fifteen cases of neonatal fungal sepsis were recruited. Over the study period, the incidence of neonatal fungal sepsis was 0.52%, while it was 2.5% in very low birth weight infants. Clinical characteristics were nonspeci-fic. All the infants were treated with parenteral nutrition and broad spectrum antibiotics. Peripheral inserted central catheter (PICC) was placed in thirteen patients. Pathogenic analyses indicated Candida glabrata was the main pathogen in our study. All the pathogens were sensitive to amphotericin B. Only one Candida glabrata was resistant to fluconazole. Thirty-four cases of bacterial sepsis were included. The clinical characteristics and laboratory examination results were compared. The platelet count was 61×10⁹/L in fungal group, while the platelet count was 178×10⁹/L in bacterial group. There was statistical difference between the fungal group and bacterial group (P=0.004). The rate of thrombocytopenia was 80.0% in fungal group, while it was 29.4% in bacterial group. It was much higher in fungal group than in bacterial group (P=0.001). The rate of PICC placement was 86.7% in fungal group, while it was 55.7% in bacterial group. It was much higher in fungal group than in bacterial group (P=0.037). Receiver operating characteristic (ROC) curve analysis showed that the cut-off value of the platelet count for the diagnosis of neonatal fungal sepsis was 145×10⁹/L (sensitivity 61.8%, specificity 92.9%). All the patients were cured after standardized antifungal therapy. The indicators of liver and renal function were also measured before and after antifungal therapy. No significant difference was observed before and after treatment. Conclusion: The clinical characteristics of neonatal fungal sepsis was nonspecific. Candida glabrata was the main pathogen in our NICU. It can be cured as the result of standardized treatment. Decreased platelet count and PICC placement may indicate the possibility of fungal sepsis in neonates.

Key words: Sepsis, Bacteremia, Fungemia, Infant, newborn, Candida

中图分类号:

R722.13

张欣, 茹喜芳, 王颖, 李星, 桑田, 冯琪. 新生儿重症监护病房中新生儿真菌败血症的临床特点[J]. 北京大学学报(医学版), 2017, 49(5): 789-793.

ZHANG Xin, RU Xi-fang, WANG Ying, LI Xing, SANG Tian, FENG Qi. Clinical characteristics of neonatal fungal sepsis in neonatal intensive care unit[J]. Journal of Peking University(Health Sciences), 2017, 49(5): 789-793.

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