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.
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
.
DOI: 10.3969/j.issn.1671-167X.2017.05.008
[1] 中华医学会儿科分会新生儿学组,中华医学会中华儿科杂志编辑委员会. 新生儿败血症诊疗方案[J]. 中华儿科杂志, 2003, 41(12): 897-899.
[2] Aliaga S, Clark RH, Laughon M, et al. Changes in the incidence of candidiasis in neonatal intensive care units [J]. Pediatrics, 2014, 133(2): 236-242.
[3] Oeser C, Vergnano S, Naidoo R, et al. Neonatal invasive fungal infection in England 2004-2010 [J]. Clin Microbiol Infect, 2014, 20(9): 936-941.
[4] Xia H, Wu H, Xia S, et al. Invasive candidiasis in preterm neonates in China: a retrospective study from 11 NICUS during 2009-2011 [J]. Pediatr Infect Disease, 2014, 33(1): 106-109.
[5] 陈晓英, 仇丽华, 江倩男, 等. 不同病原菌新生儿败血症临床特点研究[J]. 中华新生儿科杂志, 2017, 32(2): 115-118.
[6] Benjamin DK Jr, Stoll BJ, Gantz MG, et al. Neonatal candidiasis: epidemiology, risk factors, and clinical judgment [J]. Pediatrics, 2010, 126(4): e865-873.
[7] Wu Y, Wang J, Li W, et al. Pichia fabianii blood infection in a premature infant in China: case report [J]. BMC Res Notes, 2013(6): 77.
[8] Lin HC, Lin HY, Su BH, et al. Reporting an outbreak of Candida pelliculosa fungemia in a neonatal intensive care unit [J]. J Microbiol Immunol Infect, 2013, 46(6): 456-462.
[9] da Silva CM, de Carvalho Parahym AM, Leao MP, et al. Fungemia by Candida pelliculosa ( Pichia anomala ) in a neonatal intensive care unit: a possible clonal origin [J]. Mycopathologia, 2013, 175(1-2): 175-179.
[10] Pappas PG, Kauffman CA, Andes DR, et al. Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America [J]. Clin Infect Dis, 2016, 62(4): e1-50.
[11] Hope WW, Castagnola E, Groll AH, et al. ESCMID * guideline for the diagnosis and management of Candida diseases 2012: prevention and management of invasive infections in neonates and children caused by Candida spp.[J]. Clin Microbiol Infect, 2012, 18(Suppl 7): 38-52.
[12] Rios JF, Camargos PA, Correa LP, et al. Fluconazole prophylaxis in preterm infants: a systematic review [J]. Braz J Infect Dis, 2017, 21(3): 333-338.
[13] Cleminson J, Austin N, McGuire W. Prophylactic systemic antifungal agents to prevent mortality and morbidity in very low birth weight infants [J]. Cochrane Database Syst Rev, 2015(10): CD003850.
[14] Kaguelidou F, Pandolfini C, Manzoni P, et al. European survey on the use of prophylactic fluconazole in neonatal intensive care units [J]. Eur J Pediatr, 2012, 171(3): 439-445.
[15] Manzoni P, Mostert M, Castagnola E. Update on the management of Candida infections in preterm neonates [J]. Arch Dis Child Fetal Neonatal Ed, 2015, 100(5): F454-459.
