儿科住院患者假丝酵母菌医院感染的危险因素

目的分析儿科住院患者假丝酵母菌医院感染的危险因素。方法选取某院2018年1—12月儿科真菌医院感染患者为感染组,按照1∶1配对方法随机选择同一病区、同一入院时间段、同一年龄段的未发生真菌感染的儿科患者做为对照组。分析感染组患儿真菌医院感染的情况及其危险因素。结果 2018年1—12月儿科共有50例真菌医院感染患者,成功配对对照组50例。50例真菌医院感染患者主要来源科室为小儿普外科(23例)。共分离68株真菌,以近平滑假丝酵母菌为主(28株,41.18%),其次为热带假丝酵母菌(12株,17.65%)、白假丝酵母菌(11株,16.18%)。分离真菌数量居首位的科室为小儿普外科(27株),感染类型主要为血流感染(38例,占76.00%)。单因素分析显示,住院时间≥21 d、胃肠道手术、抗菌药物使用时间2周、气管插管、菌血症、静脉高营养患者的真菌医院感染发病率较高;多因素分析结果表明,抗菌药物使用2周、气管插管是儿科住院患者发生真菌医院感染的独立危险因素。检出的近平滑假丝酵母菌、热带假丝酵母菌、白假丝酵母菌、葡萄牙假丝酵母菌对两性霉素B、氟胞嘧啶的敏感率较高,为82.14%～100.00%。结论儿科住院患者真菌医院感染的主要病原体为近平滑假丝酵母菌,主要发生在小儿外科,抗菌药物使用时间2周、气管插管可增加儿童住院患者发生真菌医院感染的风险,有效的护理措施可改善患者的预后。

Risk factors for healthcare-associated Candida infection in pediatric inpatients

Objective To analyze risk factors for healthcare-associated Candida infection(Candida HAI) in pedia-tric inpatients. Methods Patients with fungal HAI in a hospital from January to December 2018 were selected as infection group, according to 1:1 matching method, patients without fungal infection in the same ward at same admission period and of same age group were randomly selected as control group, Candida HAI and risk factors in infected patients were analyzed. Results From January to December 2018, there were 50 patients with fungal HAI in department of pediatrics, and 50 cases were successfully matched in control group. Among 50 cases of fungal HAI, 23 cases were in department of pediatric general surgery. A total of 68 strains of fungi were isolated, mainly Candida parapsilosis (n=28, 41.18%), followed by Candida tropicalis (n=12, 17.65%), and Candida albicans (n=11, 16.18%). Department of pediatric general surgery ranked first in the number of isolated fungi(n=27), the main type of fungal HAI was bloodstream infection (n=38, 76.00%). Univariate analysis showed that the incidence of HAI was higher in patients with length of hospital stay ≥ 21 days, gastrointestinal surgery, duration of antimicrobial use>2 weeks, tracheal intubation, bacteremia, and intravenous hyperalimentation; multivariate analysis showed that antimicrobial use>2 weeks and tracheal intubation were independent risk factors for fungal HAI in pediatric inpatients. Resistance rates of Candida parapsilosis, Candida tropicalis, Candida albicans, and Candida lusitaniae to amphotericin B and fluorcytosine were all high (82.14%-100.00%). Conclusion The main pathogen of fungal HAI in pediatric inpatients is Candida parapsilosis, which mainly occurs in department of pedia-tric surgery, antimicrobial use>2 weeks and tracheal intubation can increase the risk of fungal HAI in pediatric inpatients, effective nursing measures can improve the prognosis of patients.