极早/超早产儿多重耐药希木龙念珠菌血流感染3例临床分析

摘要/Abstract

摘要： 目的探讨早产儿多重耐药希木龙念珠菌血流感染的临床特征、治疗及预后。方法选择2017年10月间本院新生儿重症监护病房(NICU)在住院期间发生的多重耐药希木龙念珠菌血流感染早产儿的临床资料进行回顾性分析,并复习相关文献。结果共3例患儿,为极早/超早产儿,出生胎龄分别为25周⁺¹、30周、30周,出生体重分别为725 g、1 000 g、1 070 g,发生感染时间为入院45 d、24 d、28 d,均行经外周静脉穿刺中心静脉置管(PICC),发生感染前使用过广谱抗细菌药物和低剂量氟康唑预防真菌感染。血液培养共检出4株和PICC导管尖端检出2株希木龙念珠菌,均对氟康唑、伊曲康唑、伏立康唑、两性霉素B、5-氟胞嘧啶耐药,但对米卡芬净敏感,3例用氟康唑和/或伏立康唑临床病情无改善,最终均改用米卡芬净治疗痊愈,且未见明显肝肾、血液毒副作用。结论应警惕极早/超早产儿在氟康唑预防真菌感染的过程中耐药非白念珠菌血症的发生,多重耐药希木龙念珠菌血流感染应用米卡芬净治疗安全有效。

关键词: 婴儿, 早产, 希木龙念珠菌, 血流感染, 米卡芬净

Abstract: Objective To explore the clinical characteristics,treatment and prognosis of bloodstream infection caused by multi-drug resistant Candida haemulonii in premature infants. Methods The clinical data of premature infants with candidemia caused by multi-drug resistance Candida haemulonii in October 2017 were retrospectively analyzed, and the relevant literatures were reviewed. Results The gestational age of these three very preterm/extremely preterm infants was 25 weeks^{+ 1}, 30 weeks and 30 weeks, respectively. And the birth weight was 725 g, 1 000 g and 1 070 g, respectively. The time of infection was 45, 24, 28 days after hospitalization, respectively. All 3 cases had peripheral central venous catheterization(PICC). Broad-spectrum antibiotics were administered and low doses fluconazole was used to prevent fungal infection in all cases before candidemia occurred, The total of 4 strains of Candida haemulonii isolated from the blood cultures and 2 strains from the catheter were all resistant to fluconazole, amphotericin B, itraconazole, voriconazole and 5-fluorocytosine,but were sensitive to micafengin. Fluconazole and/or voriconazole did not improve the clinical condition of 3 patients, and finally they were treated with micafengin and recovered, without obvious side-effects about liver, kidney and blood. Conclusion It should be concerned vigilantly the occurrence of multi-drug resistant non-albicans candidemia in very preterm/extremely preterm infants with fluconazole for prevention of fungal infection. Micafungin is effective and tolerated in the treatment of multidrug-resistant Candida haemulonii bloodstream infection in premature infants.

Key words: infant, premature, Candida haemulonii, bloodstream infection, micafungin

中图分类号:

R519.3

钟美珍, 郭少青, 李小忠, 朱波. 极早/超早产儿多重耐药希木龙念珠菌血流感染3例临床分析[J]. 中国真菌学杂志, 2023, 18(2): 111-116,134.

ZHONG Meizhen, GUO Shaoqing, LI Xiaozhong, ZHU Bo. Clinical analysis of 3 casesof very preterm/extremely preterm infant with bloodstream infection caused by multi-drug resistant Candida haemulonii[J]. Chinese Journal of Mycology, 2023, 18(2): 111-116,134.

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