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目的研究新生儿重症监护病房(NICU)病房早产儿真菌败血症的临床特点、高危因素、病原菌及药敏情况,指导临床防治。方法分析本院NICU病房2012年5月-2015年5月早产儿临床资料,以同期住院早产儿为对照,总结真菌败血症的高危因素、病原分布、药敏结果等加以统计分析。结果收治早产儿2 534例,经血培养确诊为真菌败血症23例,均为医院感染。其中极低出生体重儿(VLBW)早产儿14例,超低出生体重(ELBW)早产儿5例。与同期住院早产儿比较,低出生体重儿、小胎龄、静脉置管及长期静脉营养是真菌败血症的高危因素;病原均为假丝酵母菌,其中近平滑假丝酵母菌16例(69.6%),白色念珠菌6例(26.1%),无名假丝酵母菌1例(4.3%),药敏试验均对氟康唑敏感。结论极低及超低出生体重儿是院内感染真菌败血症的好发人群。病原菌以假丝酵母菌为主,对氟康唑普遍敏感。足疗程抗真菌治疗可改善预后。
Objective To study the clinical features, risk factors, pathogens and drug susceptibility of fungal sepsis in neonatal intensive care unit (NICU) ward to guide clinical prevention and treatment. Methods The clinical data of premature infants in NICU ward from May 2012 to May 2015 in our hospital were analyzed. The risk factors of fungal sepsis, the distribution of pathogens and the drug susceptibility results were analyzed statistically. Results A total of 2 534 preterm infants were admitted to our hospital and 23 cases of fungal septicemia were confirmed by blood culture. All of them were nosocomial infections. Among them, 14 were preterm infants with very low birth weight (VLBW) and 5 were premature infants with very low birth weight (ELBW). Compared with hospitalized preterm infants in the same period, low birth weight infants, small gestational age, intravenous catheterization and long-term intravenous nutrition were the risk factors of fungal sepsis. The pathogen was Candida albicans, of which 16 cases were Candida parapsilosis (69.6% ), Candida albicans 6 cases (26.1%), Candida albicans 1 case (4.3%). Susceptibility tests were sensitive to fluconazole. Conclusions Very low and very low birth weight infants are frequent occurrences of nosocomial fungal sepsis. Candida-based pathogens are generally sensitive to fluconazole. Full-course anti-fungal treatment can improve prognosis.