| 摘要: |
| 目的：分析西南地区2011-2020年新生儿真菌性败血症主要病原及药物敏感性的变迁情况，为临床优选治疗方案提供参考。方法：采用回顾性研究方法，收集2011年1月至2020年8月重庆医科大学附属儿童医院新生儿科收治的真菌性败血症患儿86例，统计分析患儿的一般临床资料、病原学特征、药敏结果、治疗及转归等。结果：86例患儿血培养检出真菌86株，其中白色假丝酵母菌47株，近平滑假丝酵母菌25株，光滑球拟酵母菌9株，葡萄牙假丝酵母菌3株，无名假丝酵母菌、季也蒙假丝酵母菌各1株。2011-2016年和2017-2020年病原菌构成比较差异无统计学意义（P>0.05）。当前国内外相关指南均推荐氟康唑和两性霉素B治疗新生儿真菌性败血症。通过2011-2016年和2017-2020年比较分析发现，主要病原菌（白色假丝酵母菌、近平滑假丝酵母菌、光滑球拟酵母菌）对氟康唑的敏感率降低（95.8% vs 78.8%，P<0.05），而对两性霉素B的敏感率差异无统计学意义（91.7% vs 97.0%，P>0.05）。结论：西南地区新生儿真菌性败血症病原以假丝酵母菌为主，对两性霉素B仍保持较高敏感性，而对氟康唑的敏感性有降低趋势。对于临床诊断真菌感染而培养阴性的患儿，给予两性霉素B治疗可能是优选策略 |
| 关键词: 新生儿 败血症 真菌 药敏 变迁 |
| DOI：10.13407/j.cnki.jpp.1672-108X.2021.07.006 |
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| 基金项目: |
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| Pathogens and Drug Sensitivity Changes of Neonatal Fungal Sepsis in Southwest China from 2011 to 2020 |
| Yang Yingtian1, Liu Xiaochen2, Li Luquan2 |
| (1. Sichuan Bazhong Central Hospital, Sichuan Bazhong 636000, China; 2. Children’s Hospital of Chongqing Medical University, Chongqing 400014, China) |
| Abstract: |
| Objective: To analyze the main pathogens and drug sensitivity changes of neonatal fungal septicemia in southwest China from 2011 to 2020, so as to provide reference for clinical optimal treatment. Methods: Clinical data of 86 cases of septicemia with fungal infection admitted into the neonatology of Children’s Hospital of Chongqing Medical University from Jan. 2011 to Aug. 2020 were retrospectively analyzed. The general data, pathogenic characteristics, drug sensitivity results, treatment and outcome were statistically analyzed. Results: Totally 86 strains of fungi were detected in the blood cultures of 86 children, including 47 strains of Candida albicans, 25 strains of Candida paraplata, 9 strains of Saccharomyces glabrata, 3 strains of Candida portuguese, 1 strain of Candida famata and 1 strain of Candida guilliermind. There was no statistically significant difference in pathogenic bacteria composition from 2011 to 2016 and from 2017 to 2020 (P>0.05). The domestic and international guidelines recommended fluconazole and amphotericin B for the treatment of neonatal fungal sepsis. Through the comparative analysis from 2011 to 2016 and from 2017 to 2020, the drug sensitivity of the main pathogenic bacteria (C. albicans, C. paraplata and S. glabrata) to fluconazole decreased (95.8% vs 78.8%, P<0.05), and there was no significant difference in sensitivity to amphotericin B (91.7% vs 97.0%, P>0.05). Conclusion: The pathogens of neonatal fungal sepsis in the southwest are mainly Candida, which still maintains the high sensitivity to amphotericin B, while the sensitivity to fluconazole has a tendency to decrease. In children with clinically diagnosed fungal infections and negative cultures, treatment with amphotericin B may be the preferred strategy |
| Key words: neonates sepsis fungi drug sensitivity changes |
