婴儿院内肺部真菌感染的危险因素

目的 探讨新生儿科住院患儿院内肺部真菌感染(NIPFI)的流行病学及其危险因素.方法 选取2006年7月1日-2008年6月30日在广东省人民医院新生儿科住院的患儿中符合院内深部真菌感染(NIFI)诊断标准的婴儿日龄(77±61) d]共68例.收集患儿一般资料、感染前诊疗经过、标本类型等,并对NIPFI及其他NIFI患儿各项数据进行比较.应用SPSS 13.0软件进行统计学分析.结果 住院患儿NIFI发病率为3.31%(68/2 052例),其中NIPFI发生率为1.36%(28/2 052例).NIPFI患儿总住院时间中位数为15.50 d;心血管疾病患病率为94.6%,感染真菌前广谱抗生素的使用率为96.4%,抗生素的联合应用占64.3%;78.6%的患儿接受了心脏手术;机械通气率为82.1%;中心静脉置管为67.9%;留置胃管率为96.4%;激素使用者占78.6%.NIPFI患儿机械通气率较其他NIFI患儿高(χ2=7.32,P=0.010);余因素在2组患儿间比较差异均无统计学意义.多元回归分析显示机械通气与NIPFI有显著相关性(OR=0.229,95%CI 0.072～0.725,P=0.012).结论 在NIFI的各种危险因素中,机械通气是NIPFI的危险因素.

Risk Factors of Nosocomial Invasive Pulmonary Fungal Infection in Infants

Objective To explore the epidemiology of nosocomial invasive pulmonary fungal infection(NIPFI) in the Department of Neonatology and analyze the risk factors,provide evidence for proper diagnostic and treating handlings.Methods Sixty-eight infants which aged(77±61) d with nosocomial invasive fungal infection(NIFI),who hospitalized in Guangdong General Hospital from Jul.1,2006 to Jun.30,2008 were enrolled in the study.All the clinical data,including general situation,pre-infection management,types of collected samples and the data of NIPFI and other NIFI were retrospectively analyzed.SPSS 13.0 software was used to analyze the data.Results The incidence of NIPFI was 1.36%(28/2 052 cases).The median hospital stay before NIPFI was 15.50 days.All the patients suffered from more than one critical primary diseases,94.6% of which were congenital cardiovascular disease,96.4% of the infants were managed with broad antimicrobial spectrum antibiotic,and 64.3% with antibiotics,78.6% of the infants received cardiovascular operations,glucocorticoid was used in 78.6%,central venous catheter indwelled in 67.9%,nasal-stomach tubes in 96.4%,82.1% patients were mechanically ventilated,which was significantly higher than that in other NIFI patients(χ2=7.32,P=0.010).Multiple regression analysis showed that NIPFI was positively correlated with mechanical ventilation(OR=0.229,95%CI 0.072-0.725,P=0.012).Conclusion Of all the risk factors for nosocomial invasive fungal infection,mechanical ventilation is the risk factor for NIPFI.