儿童念珠菌血症的临床特点及耐药性分析

摘要/Abstract

摘要： 目的分析念珠菌血症患儿的临床特点，为儿童念珠菌血症的诊治提供临床经验。方法回顾性分析2014年1月至2020年12月重庆医科大学附属儿童医院血标本念珠菌培养阳性患儿的病历资料，并根据血培养结果分为白念珠菌组与非白念珠菌组，比较两组临床特征的差异。结果共纳入124例，念珠菌检出率最高的科室是新生儿病房、血液肿瘤病房及重症监护病房。检出率最高的菌种是白念珠菌（61例，49.2%），其次是近平滑念珠菌（26例，21.0%）和热带念珠菌（14例，11.3%），念珠菌对伊曲康唑、伏立康唑及氟康唑三种药物的耐药率较高，分别为16.5%、12.6%、11.6%。与白念珠菌组相比，非白念珠菌组在肿瘤性疾病、化疗后骨髓抑制中感染率更高（P<0.05）。使用β内酰胺类及酶抑制剂、静脉置管、静脉营养者易感染白念珠菌，使用免疫抑制剂以及中性粒细胞缺乏者易感染非白念珠菌（P<0.05）。白念珠菌组在C反应蛋白>8 mg/L、白细胞≥ 10×10⁹/L及中性粒细胞百分比>80%的发生率较非白念珠菌组高，后者在合并败血症及对两性霉素B的耐药率较前者更高（P<0.05）。结论儿童念珠菌血症基础疾病重、危险因素复杂，临床表现不典型，不利于早期诊断，容易漏诊、误诊。因此，对具有高危因素的儿童及临床抗感染治疗效果不好时，需警惕念珠菌血症的可能，应及时完善相关检查助诊。

关键词: 念珠菌血症, 临床特点, 危险因素, 耐药性, 儿童

Abstract: Objective To investigate the clinical characteristics of children with candidemia, and provide clinical experience for the diagnosis and treatment of candidemia. Methods A retrospective analysis was carried out to analysis the Candida isolates from blood from the Children's Hospital of Chongqing Medical University from January 2014 to December 2020,and they were divided into Candida albicans and non-albicans Candida, the differences in clinical characteristics between the two groups were compared. Results A total of 124 cases were enrolled, these patients mainly came from the department of neonatology, the department of hematologic oncology and the department of ICU. Candida albicans (61cases, 49.2%) had the highest detection rate, followed by Candida parapsilosis (26 cases, 21.0%) and Candida tropicalis (14 cases, 11.3%). The resistance rates of Candida to itraconazole, voriconazole and fluconazole were 16.5%, 12.6% and 11.6% respectively. Compared with Candida albicans, the non-albicansCandida had higher infection rate in tumorous diseases and bone marrow suppression after chemotherapy(P<0.05). Those who used β-lactams and enzyme inhibitors, intravenous catheters, and intravenous nutrition were susceptible to Candida albicans, and those who used immunosuppressive agents and neutropenia were susceptible to non-albicans Candida (P<0.05). The incidence of C-reactive protein >8mg/L,white blood cell ≥ 10×10⁹/L and neutrophilic granulocyte percent > 80% in Candida albicans was higher than that in non-albicans Candida,and the rate of sepsis and resistance to amphotericin B in non-albicans Candida was higher than that in Candida albicans (P<0.05). Conclusion Candidemia had serious underlying diseases, complex risk factors, atypical clinical manifestations, which was not conducive to early diagnosis, and was easy to missed diagnose and misdiagnose. Therefore, for children with high-risk factors and when the clinical anti-infection treatment is not effective, it is necessary to be alert to the possibility of candidemia, and relevant examinations should be improved in time for early diagnosis.

Key words: candidemia, clinical features, risk factors, drug resistance, children

中图分类号:

R 519.3 A

张伶玲, 刘泉波. 儿童念珠菌血症的临床特点及耐药性分析[J]. 中国真菌学杂志, 2022, 17(6): 467-471,481.

ZHANG Lingling, LIU Quanbo. Clinical characteristics and drug resistance analysis of candidemia in children[J]. Chinese Journal of Mycology, 2022, 17(6): 467-471,481.

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