目的：探讨早产儿白假丝酵母菌败血症的临床特点。方法：回顾性分析13例早产儿白假丝酵母菌败血症患儿的临床资料。患儿胎龄28~36周，体重1400~2815 g。结果：患儿发生白假丝酵母菌感染的时间为生后19±11 d。临床表现主要为：呼吸暂停、皮肤灌注差、反应差、反复血氧下降、皮肤灰暗、皮肤黄染、安静状态心率增快、痰多、撤机困难。在白假丝酵母菌感染时患儿血小板明显下降，C反应蛋白、血小板分布宽度升高。谷丙转氨酶、肌酸激酶同工酶、总胆红素、肌酸激酶、乳酸脱氢酶在白假丝酵母菌感染时升高，抗真菌治疗两周后肌酸激酶、乳酸脱氢酶下降明显。仅3例对氟康唑耐药,换用伏立康唑治疗有效，10例治愈，放弃治疗2例，死亡1例。结论：早产儿白假丝酵母菌败血症临床表现非特异性，生后2~3周的早产儿并发的感染，应考虑白假丝酵母菌感染的可能。白假丝酵母菌感染时，患儿血小板下降，C反应蛋白、血小板分布宽度升高、谷丙转氨酶、肌酸激酶同工酶、总胆红素、肌酸激酶、乳酸脱氢酶升高。
Abstract
OBJECTIVE: To investigate the clinical features of Candida albicans sepsis in preterm infants. METHODS: Retrospective analysis was performed on the clinical data of 13 preterm infants with Candida albicans sepsis, who were born at 28 to 36 weeks of gestational age and who weighed between 1400 and 2815 g. RESULTS: The infants were infected with Candida albicans at the age of 19±11 d, with the main clinical manifestations being apnea, poor response, poor skin perfusion, blood oxygen concentration decrease, dark skin, yellowish skin, heart rate increase in the rest state, copious phlegm and difficulty in weaning from the ventilator. The infants showed significantly decreased platelet and increased C-reactive protein (CRP), platelet distribution width (PDW), alanine transaminase (ALT), creatine kinase isoenzyme-MB (CK-MB), total bilirubin (TBIL), creatine kinase (CK), and lactate dehydrogenase (LDH). CK and LDH were significantly decreased after 2 weeks of antifungal therapy. Only 3 cases developed drug resistance to fluconazole and these showed response when treated with voriconazole instead. Of the 13 cases, 10 were cured, 2 abandoned therapy and 1 died. CONCLUSIONS: The clinical manifestations of Candida albicans sepsis are nonspecific in preterm infants. Infectious diseases are probably caused by Candida albicans in preterm infants 2-3 weeks after birth. Preterm infants show decreased platelet and increased CRP, PDW, ALT, CK-MB, TBIL, CK, and LDH when infected with Candida albicans.
关键词
败血症 /
白假丝酵母菌 /
临床特点 /
早产儿
Key words
Sepsis /
Candida albicans /
Clinical feature /
Preterm infant
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
［1］Wisplinghoff H, Bischoff T, Tallent SM, Seifert H, Wenzel RP, Edmond MB. Nosocomial bloodstream infections in US hospitals:analysis of 24,179 cases from a prospective nationwide surveillance study［J］. Clin Infect Dis, 2004, 39(3): 309-317.
［2］Long SS, Stevenson DK. Reducing Candida infections during neonatal intensive care: management choices, infection control, and fluconazole prophylaxis［J］. J Pediatr, 2005, 147(2): 135-141.
［3］Xavier PC, Chang MR, Nunes MO, Palhares DB, Silva RA, Bonfim GF, et al. Neonatal candidemia in a public hospital in Mato Grosso do Sul［J］. Rev Soc Bras Med Trop, 2008, 41(5): 459-463.
［4］Fridkin SK, Kaufman D, Edwards JR, Shetty S, Horan T. Changing incidence of Candida bloodstream infections among NICU patients in the United States: 1995-2004［J］. Pediatrics, 2006, 117(5): 1680-1687.
［5］Chang MR, Correia FP, Costa LC, Xavier PC, Palhares DB, Taira DL, et al. Candida bloodstream infection: data from a teaching hospital in Mato Grosso do Sul, Brazil［J］. Rev Inst Med Trop Sao Paulo, 2008, 50(5): 265-268.
［6］Montagna MT, Lovero G, De Giglio O, Iatta R, Caggiano G, Montagna O, et al. Invasive fungal infections in neonatal intensive care units of Southern Italy: a multicentre regional active surveillance (AURORA project)［J］. J Prev Med Hyg, 2010, 51(3): 125-130.
［7］Cohen-Wolkowiez M, Benjamin DK Jr, Piper L, Cheifetz IM, Moran C, Liu P, et al. Safety and pharmacokinetics of multiple-dose anidulafungin in infants and neonates［J］. Clin Pharmacol Ther, 2011, 89(5): 702-707.
［8］邵肖梅，叶鸿瑁，丘小汕. 实用新生儿学［M］. 第4版.北京：人民卫生出版社, 2011.
［9］胡娅，余加林，新生儿假丝酵母菌血症流行病学及易患因素研究进展［J］.中国新生儿科杂志，2006，21(3):115-117.
［10］杨玉霞,栾斌,乔俊英,王新霞. 160例新生儿真菌性肺炎的高危因素分析［J］.中国当代儿科杂志，2008，12(6):705-707.
［11］Carey AJ, Saiman L, Polin RA. Hospital-acquired infections in the NICU: epidemiology for the new millennium［J］. Clin Perinatol, 2008, 35(1): 223-249.
［12］董青艺，陈平洋，谢宗德，贺晓日，李雯, 赵子艳. 新生儿真菌败血症22例临床分析［J］. 中国实用儿科杂志，2010，25(5):379-382.
［13］Saiman L, Ludington E, Dawson JD, Patterson JE, Rangel-Frausto S, Wiblin RT, et al. Risk factors for Candida species colonization of neonatal intensive care unit patients［J］. Pediatr Infect Dis J, 2001, 20(12): 1119-1124.
［14］Kaufman D, Fairchild KD. Clinical microbiology of bacterial and fungal sepsis in very-low-birth-weight infants［J］. Clin Microbiol Rev, 2004, 17(3): 638-680.
［15］Berger C, Uehlinger J, Ghelfi D, Blau N, Fanconi S. Comparison of C-reactive protein and white blood cell count with differential in neonates at risk for septicaemia［J］. Eur J Pediatr, 1995, 154(2): 138-144.
［16］Warkentin TE, Aird WC, Rand JH. Platelet-endothelial interactions: sepsis, HIT, and antiphospholipid syndrome［J］. Hematology Am Soc Hematol Educ Program, 2003: 497-519.
［17］Torkaman M, Afsharpaiman SH, Hoseini MJ, Moradi M, Mazraati A, Amirsalari S, et al. Platelet count and neonatal sepsis: a high prevalence of Enterobacter spp［J］. Singapore Med J, 2009, 50(5): 482-485.
［18］Sharma R, Tepas JJ 3rd, Hudak ML, Mollitt DL, Wludyka PS, Teng RJ, et al. Neonatal gut barrier and multiple organ failure: role of endotoxin and proinflammatory cytokines in sepsis and necrotizing enterocolitis［J］. J Pediatr Surg, 2007, 42(3): 454-461.
［19］Warris A, Semmekrot BA, Voss A. Candidal and bacterial bloodstream infections in premature neonates: a case-control study［J］. Med Mycol, 2001, 39(1): 75-79.
PDF(926 KB)
