新生儿重症监护病房真菌血症病原学及临床分析

目的探讨自2004年1月至2008年12月我院新生儿重症监护病房获得性真菌血症病原学及临床特征,为真菌血症防治提供依据。方法回顾分析5年中新生儿重症监护室发生的33例真菌血症的病原学和临床资料。结果33例真菌血症均为医院获得感染的假丝酵母菌,其中白色假丝酵母菌17株、热带假丝酵母菌10株、近平滑假丝酵母菌5株、光滑假丝酵母菌1株。结论假丝酵母菌属是新生儿重症监护病房真菌血症的主要致病菌,以白色假丝酵母菌最常见,但非白色假丝酵母菌也占较大比例;真菌血症与早产、极低体重儿、机械通气、静脉导管、全胃肠外营养等因素有关。5-氟脲嘧啶、伊曲康唑、两性霉素B和氟康唑对假丝酵母菌耐药性较低,氟康唑是治疗假丝酵母菌属的有效药物。

Etiological and Clinical Analysis of Nosocomial Fungemia in A Neonatal Intensive Care Unit

Objective To evaluate the clinical and microbiological characteristics of nosocomial fungemia in a neonatal intensive care unit from January 2004 to December 2008,and to provide evidence for prevention and therapy.Methods Clinical and Etiological data of 33 cases of nosocomial fungicidal infection in a neonatal intensive care unit were analysed.Results All cases were confirmed as hospital-acquired infection.The majority of isolates was Candida albicans（17 cases）.10 cases were Candida tropicalis infection,5 cases of Candida Parapsilosis and 1 case of Candida tropicalis infection.Conclusion Candida is the most common pathogen causing nosocomial fungemia in neonatal intensive care unit in our hospital.Candida albicans was the major etigological agent,but most fungemia cases were non-candidemia.The risk factors for invasive fungemia include prematunity（especially in VLBW neonates）,mechanical ventilation,indwelling central intravenous catheter and total parentenral alimentation.The drug resistance of the isolates to 5-fluorocytosine,itraconazole,amphotericin B and fluconazole was relatively low.Fluconazole remains effective for the treatment of Candida infections.