Objective To discuss the clinical characteristics of fungal sepsis in very low birth weight infants (VLBWI), and to provide reference for early diagnosis and treatment of fungal sepsis. Methods The clinical data of 17 cases of VLBWI who were diagnosed with fungal sepsis in NICU were retrospectively analyzed. Results 287 cases of VLBWI (including extremely low birth weight infants) were treated from January 2008 to May 2011, among whom 17 cases were diagnosed with fungal sepsis, and the incidence was 5.92％. Before infection, all the 17 cases of fungal sepsis had received broad-spectrum antibiotics and intravenous nutrition, 14 cases had received mechanical ventilation,and 13 cases had received peripherally inserted central catheter (PICC). The earliest onset date was 7 days after birth;the latest onset date was 51 days after birth. The clinical manifestation of fungal sepsis had no specificity. The level of plasma fungal (1, 3)-1β-D glucan in all cases rose obviously (46 - 8 285 pg/ml). Blood culture results indicated 9cases with Candida a/bicans, 4 cases with Candida krusei, 2 cases with Candida parapsilosis, and 2 cases with unknow Candida. Drug sensitive test showed that all the fungal strains were sensitive to fluconazole and amphotericin B.All the 17 cases had been treated with fluconazole at the onset, but 8 cases changed to liposomal amphotericin B because of the poor efficacy. Thirteen cases were cured, 3 cases were given up, and one case was died. Conclusions The incidence of fungal sepsis in VLBWI is still quite high. The pathogenic strains are mainly Candida albicans and Candida krusei. The iatrogenic factors such as the use of broad-spectrum antibiotics, PICC and mechanical ventilation can not be ignored. The clinical manifestation of fungal sepsis has no specificity. The level of plasma fungal ( 1, 3)-13-D glucan can be used as an important index of diagnosis, treatment and prognosis of fungal sepsis. The treatment of fungal sepsis with fiuconazole and amphotericin B is quite efficient.%目的 探讨极低出生体质量儿(VLBWI)真菌性败血症的临床特征,为其早期诊断及治疗提供参考依据.方法 对新生儿重症监护室(NICU)确诊为真菌性败血症的17例VLBWI的临床资料进行回顾性分析.结果 2008年1月至2011年5月共收治VLBWI(含超低出生体质量儿)287例,确诊真菌性败血症17例,发生率为5.92%.17例真菌性败血症患儿在真菌感染前均接受过广谱抗生素和静脉营养治疗,14例曾机械通气,13例曾留置经外周的中心静脉导管(PICC).起病最早为生后7 d,最晚为生后51 d.真菌性败血症的临床表现无特异性,检测血浆(1,3)-β-D葡聚糖(BG)均明显升高(46 ～ 8 285 pg/ml).血培养白色假丝酵母菌9例,克柔假丝酵母菌4例,近平滑假丝酵母菌2例,无名假丝酵母菌2例.药敏试验显示所有菌株对氟康唑和两性霉素B均敏感.17例起初均予氟康唑治疗,其中8例因疗效欠佳改用两性霉素B脂质体治疗.治愈13例,自动出院3例,1例死亡.结论 VLBWI真菌性败血症的发生率仍较高,病原菌主要为白色假丝酵母菌和克柔假丝酵母菌,医源性因素如广谱抗生素的使用、中心静脉置管、机械通气等不容忽视.患儿临床表现无特异性,血浆BG检测可作为真菌性败血症的诊断、疗效及预后判断的重要指标.氟康唑及两性霉素B脂质体治疗真菌性败血症效果较好.
展开▼
