CAJ | 학술논문

目的分析儿童重症监护病房(PICU)侵袭性真菌感染的特点及危险因素.方法总结2007年至2009年我院PICU收治的35例发生侵袭性真菌感染患儿的临床资料,对真菌感染危险因素进行分析,包括危重病例评分、机械通气、导尿管和胃管置入、床旁血液净化治疗等.结果 (1)3年间PICU共收治危重患儿2 116例,其中35例发生真菌感染,发生率为1.65%(35/2 116),其中死亡7例,病死率为20.00%(7/35).(2)发生真菌感染的平均时间为人院后(10.4±8.3)d,主要表现为肺炎21例(60.0%),腹膜炎5例(14.3%),尿路感染4例(11.4%),肠道感染3例(8.6%),败血症1例(2.9%),脑膜炎1例(2.9%).(3)儿童危重病例评分低、机械通气、留置胃管及导尿管、连续性静脉血液透析滤过是引起真菌感染的危险因素.(4)致病菌以白色念珠菌为主.结论侵袭性真菌感染已成为PICU主要的院内感染,白色念珠菌是主要致病菌.合理利用抗生素、减少不必要的侵入性操作、及时使用抗真菌药,可能是应对侵袭性真菌感染的有效策略.
목적 분석인동중증감호병방(PICU)침습성진균감염적특점급위험인소.방법 총결2007년지2009년아원PICU수치적35례발생침습성진균감염환인적림상자료,대진균감염위험인소진행분석,포괄위중병례평분、궤계통기、도뇨관화위관치입、상방혈액정화치료등.결과 (1)3년간PICU공수치위중환인2 116례,기중35례발생진균감염,발생솔위1.65%(35/2 116),기중사망7례,병사솔위20.00%(7/35).(2)발생진균감염적평균시간위인원후(10.4±8.3)d,주요표현위폐염21례(60.0%),복막염5례(14.3%),뇨로감염4례(11.4%),장도감염3례(8.6%),패혈증1례(2.9%),뇌막염1례(2.9%).(3)인동위중병례평분저、궤계통기、류치위관급도뇨관、련속성정맥혈액투석려과시인기진균감염적위험인소.(4)치병균이백색념주균위주.결론 침습성진균감염이성위PICU주요적원내감염,백색념주균시주요치병균.합리이용항생소、감소불필요적침입성조작、급시사용항진균약,가능시응대침습성진균감염적유효책략.
Objective To analyze the incidence,clinical feature and the risk factors of invasive fungal infection in pediatric intensive care unit (PICU). Methods We retrospectively summaried the invasive fungal infection in our PICU from Jan 2007 to Dec 2009 in order to analyze the incidence, clinical feature and the risk factors of invasive fungal infection in PICU. Multiple clinical data were collected such as pediatric critical illness score, mechanical ventilation, urinary drainage tube, indwelling gastric canal and continuous blood purification. Results ( 1 ) The incidence rate of invasive fungal infection was 1.65 % ( 35/2 116 ). The morbidity was 20. 00% ( 7/35 ). ( 2 ) Mean infected day was ( 10. 4 ±- 8. 3 ) d after admission. The clinical manifestations included fungal pneumonia( 60. 0% ), peritonitis ( 14. 3% ), urinary tract infection ( 11.4% ),intestinal tract infection(8. 6% ) ,sepsis(2. 9% ) and meningitis(2. 9% ). All of the patients had used broad spectrum antibiotic. (3) The risk factors of invasive fungal infection included lower pediatric critical illness score, mechanical ventilation, indwelling gastric tube, urinary drainage tube and continuous blood purification.(4) Candia albicans was the predominant pathogen in invasive fungal infection. Conclusion Invasive fungal infection has become one of the main nosocomial infection in PICU. Lung is most commonly involved and candida albicans is the major pathogen. Using antibiotics appropriately, decreasing unnecessary invasive performance,and rationally using antifungal agent mi.ght be effective strategy for invasive fungal infection in PICU.