摘要目的 总结PICU侵袭性真菌感染(invasive fungal infection,IFI)的临床特点,并分析其危险因素.方法 回顾性分析2013年1月至2017年12月在我院PICU住院的IFI患儿的临床资料.结果 标本真菌培养阳性患儿179例,其中IFI患儿49例.男23例,女26例,平均年龄(3.87 ±2.42)岁.47例患儿存在基础疾病.阳性标本中肺泡灌洗液/痰培养36例,血培养14例,尿培养7例,胸/腹水培养3例,骨髓培养2例,脑脊液培养1例.12例患儿同时存在2个及以上部位感染.共培养出53株真菌:念珠菌45株,曲霉菌5株,马尔尼菲青霉菌3株.4例患儿存在两种真菌感染.存在基础疾病、输血、使用抗生素/糖皮质激素/免疫抑制剂、侵袭性操作、住院时间长是IFI的危险因素(均P＜0.05).药敏分析结果显示,除产朊假丝酵母菌、酿酒酵母菌、葡萄牙假丝酵母菌各1例对伊曲康唑不敏感外,其他菌株对两性霉素B/脂质体、三唑类、棘白菌素类抗真菌药物均敏感.23例患儿联合使用2种抗真菌药物.所有患儿均伴有发热,11例发生多器官功能障碍综合征,6例死亡.结论 儿童IFI患者临床表现缺乏特异性,病情重,病死率高.念珠菌是最常见的病原菌,肺是最常见的感染部位.对于存在IFI危险因素如基础疾病、输血、使用抗生素/糖皮质激素/免疫抑制剂、侵袭性操作、住院时间长的患儿,应结合实验室检查鉴别诊断,及早诊断并经验性合理使用抗真菌药物.

abstractsObjective To investigate the clinical characteristics of invasive fungal infections(IFI) in PICU and analyze the risk factors for diagnosis and treatment earlier.Methods The clinical data of patients with IFI hospitalized in PICU from January 2013 to December 2017 were retrospectively studied.Results There were 179 cases of patients with positive fungal cultures,of which 49 cases were IFI.There were 23 males and 26 females,the mean age was (3.87 ± 2.42) years.A total of 47 cases had underlying diseases.In positive specimen,there were 36 cases of bronchoalveolar lavage fluid or sputum cultures,14 cases of blood cultures,7 cases of urinary cultures,3 cases of thoracic/ascites cultures,2 cases of bone marrow cultures,and 1 case of cerebrospinal fluid culture.There were 12 cases who had at least two sites infection at the same time.A total of 53 strains of fungal pathogens were cultivated,among which 45 cases were candida,5 cases were aspergillus,and 3 cases were penicillium marneffei,and 4 cases had two fungal infections.The presence of underlying diseases,blood transfusions,use of antibiotics/glucocorticoids/immunosuppressors,invasive procedures,and long hospital stays were risk factors (all P ＜ 0.05).Drug susceptibility analysis showed that all strains were sensitive to antifungal drugs of amphotericin B/liposomes,azoles and echinocandins,except 1 case of Candida utilis,1 case of Saccharomyces cerevisiae and 1 case of Candida lusitaniae.There were 26 patients only treated with one antifungal drug and 23 had combined drugs.All patients had fever.Eleven patients developed multiple organ dysfunction syndrome and 6 died.Conclusion There are no specific clinical manifestations for children with IFI and with critical condition and high mortality.Candida is the most common fungal infection.The lung is the most common part of infection.The children of IFI with risk factors such as underlying diseases,blood transfusions,use of antibiotics/glucocorticoids/immunosuppressors,invasive procedures and long hospital stays,should be identified in combination with laboratory examination and use antifungal drugs rationally as early as possible.