儿童重症监护病房侵袭性真菌感染38例临床分析

Invasive fungal infections in the pediatric intensive care unit: a clinical analysis of 38 cases

摘要:

目的：探讨儿童重症监护病房（PICU）侵袭性真菌感染（IFI）的临床特征，为其有效防治提供依据。方法：回顾性分析38例IFI患儿的临床特征及治疗转归情况。结果：38例患儿中，以呼吸道感染最多见（89%）；感染前均有较严重的基础疾病，且使用过多种抗生素，其中碳青霉烯类抗生素使用率高达95%；47%患儿曾全身激素治疗；所有患儿均有侵入性操作史，其中47%患儿接受过气管插管及机械通气治疗；所有患儿临床症状及体征不典型，影像学检查无特异性。真菌培养共检出致病真菌56株，以白色念珠菌为主（41%），其次为曲霉菌（25%）和毛霉菌（20%）；所有患儿及时予以高效抗真菌药物治疗，治愈15例，好转16例，有效率为82%，不良反应发生率为16%。结论：呼吸道为最常见IFI感染部位；白色念珠菌为主要病原；多数患儿有严重基础疾病、广谱抗生素及糖皮质激素的使用史和侵入性操作史；早期诊断、及时使用高效抗真菌药物可改善预后。

Abstract:

OBJECTIVE: To investigate the clinical features of invasive fungal infections (IFI) in the pediatric intensive care unit (PICU) and, to provide a basis for the effective prevention and treatment of IFI. METHODS: Retrospective analysis was performed on the clinical features and treatment outcomes of 38 children with IFI who were admitted to the PICU of Wuhan Children’s Hospital between January 2009 and August 2012. RESULTS: Pulmonary fungal infection (89%) was the most common among the 38 cases. Before diagnosis of IFI, all patients had severe underlying diseases and received several broad-spectrum antibiotics, including carbapenems, which were used in 95% of cases; 47% of all cases had been treated with corticosteroids systemically; all patients had received invasive operations, and 47% of them had undergone endotracheal intubation and mechanical ventilation. None of these cases had either typical clinical symptoms and signs or specific imaging findings. Fifty-six strains of fungi were isolated, with Candida albicans (41%), Aspergilli (25%), and Mucor (20%) being the most common ones. All patients received timely antifungal therapies, 15 cases were cured and 16 cases showed improvements, with a response rate of 82%, and the rate of adverse events was 16%. CONCLUSIONS: In the PICU, the respiratory tract is the most common site of IFI infection, and Candida albicans is the leading pathogen. Severe underlying diseases, use of broad-spectrum antibiotics and corticosteroids, and invasive operations are the main risk factors for IFI in the PICU. Early diagnosis and timely treatment with high-performance antifungal drugs can improve the prognosis in children with IFI.