Clinical research of nosocomial invasive fungal bloodstream infections in PICU children:A clinical analysis of 21 cases / 中国实用儿科杂志

ABSTRACT

OBJECTIVE: To improve the understanding of the IFI,and to help the early diagnosis and treatment and positive improvement of prognosis. METHODS: A total of 21 children were chosen as the research subjects,who were diagnosed with the IFI bloodstream infection and were hospitalized in Shengjing Hospital affiliated to China Medical University from January2012 to January 2018,and the clinical characteristics,high risk factors and prognosis of them were retrospectively analyzed.RESULTS: Therewasnosignificantcorrelationbetweentheincidenceoffungalinfectionandageorsexin 21 children with IFI bloodstream infection. Candida albicans and Candida parapsilosis were the leading pathogen,and the mortality rate of Candida parapsilosis was high(80%).For the 21 children with IFI bloodstream infection,the mortality rate was as high as 61.9%(13 cases)with 28 days' following research. The protopathy was mainly respiratory system disease(14.29%)and digestive system disease(23.81%). Among them,there were 4 cases of severe pneumonia and 4 cases of gastrointestinal perforation. The high risk factors were mainly the combined use of broad-spectrumantibiotics,invasive operation(tracheal intubation,central venous catheterization,catheterization and indwelling stomach tube,etc.),long-term hospitalization in ICU and so on,all above 85%.Fungal infection was characterized by atypical fever(80.95%),abnormal increase or decrease of white blood cells(47.62%)andCRPincrease(80.95%);thepositiverateof Gtest couldreach 42.86%. Inthesurvival groupincluding 8 casesof children,75% were treated with antifungal treatment before diagnosed with fungal infection;the rate of preventive drug use was 53.85%for the death group. CONCLUSION: Long-termhospitalization in ICU,long-termand combined use of a large amount of broadspectrum antibiotics,invasive operation,autoimmune deficiency and other factors increase the risk of fungal infection. If there is atypical refractory infection after clinical primary diseases,fungal infection should be paid attention to and the related microbiological examination should be performed.