儿童重症监护病房医院感染暴发白色念珠菌血流感染4例分析

摘要 目的：探讨儿童重症监护病房白色念珠菌血流感染暴发的临床表现、危险因素、控制措施等，为预防和控制院内白色念珠菌血流感染暴发提供科学依据。方法：以2018年7月我院儿童重症监护病房发生的4例白色念珠菌血流感染暴发患儿为研究对象，分析患儿临床情况、临床特征、危险因素、暴发原因以及采取的预防控制措施。结果：4例医院感染暴发白色念珠菌血流感染患儿均存在基础疾病、有机械通气史、存在中心静脉或动脉置管、静脉或动脉置管前后均使用碘伏消毒、曾使用广谱抗生素、输血制品，白色念珠菌血流感染后最突出的临床表现均是发热。药敏方面，医院感染暴发的4例白色念珠菌感染患儿对唑类及5-氟胞嘧啶均耐药，但对两性霉素B均敏感。经拔除血管置管、减少或者避免广谱抗菌药的应用，根据药敏使用卡泊芬净及两性霉素B抗真菌等积极治疗，1例患儿放弃治疗后死亡，3例患儿顺利出院。通过Fisher确切概率法分析可知，留置中心静脉或动脉置管是儿童重症监护病房发生医院感染暴发白色念珠菌血流感染的危险因素（P<0.05）。结论：留置中心静脉或动脉置管是儿童重症监护病房发生医院感染暴发白色念珠菌血流感染的危险因素，医院感染暴发白色念珠菌血流感染患儿最突出的临床表现是发热，唑类及5-氟胞嘧啶耐药的患儿使用卡泊芬净及两性霉素B可能获得较好的治疗效果。

Analysis of 4 Cases of Candida Albicans Bloodstream Infection in Pediatric Intensive Care Unit

ABSTRACT Objective: To investigate the clinical manifestations, risk factors and control measures of Candida albicans bloodstream infection outbreak in children''s intensive care unit, so as to provide scientific basis for the prevention and control of Candida albicans bloodstream infection outbreak in hospital. Methods: 4 children with Candida albicans bloodstream infection outbreak in our children''s intensive care unit in July 2018 were selected as the research objects. The clinical situation, clinical characteristics, risk factors, causes of the outbreak and preventive and control measures were analyzed. Results: The 4 children with Candida albicans bloodstream infection in the outbreak of nosocomial infection all had basic diseases, a history of mechanical ventilation, central vein or arterial catheterization, iodophor disinfection before and after intravenous or arterial catheterization, broad-spectrum antibiotics and blood transfusion products, the most prominent clinical manifestation of Candida albicans bloodstream infection was fever. In terms of drug sensitivity, 4 children infected with Candida albicans from the outbreak of nosocomial infection were resistant to azole and 5-fluorocytosine, but sensitive to amphotericin B. After removing vessels and placing tubes, reducing or avoiding the application of broad-spectrum antimicrobial drugs, and active treatment with antifungal drugs such as caspofungine and amphotericin B according to drug sensitivity, 1 child died after giving up treatment, and 3 children were discharged successfully. According to Fisher''s exact probability method analysis, indwelling central vein or arterial catheterization was a risk factor for nosocomial infection outbreaks of Candida albicans bloodstream infection in pediatric intensive care units (P<0.05). Conclusion: Indwelling central venous or arterial catheterization is a risk factor for nosocomial infection outbreak of Candida albicans bloodstream infection in children''s intensive care unit. The most prominent clinical manifestation of children with nosocomial infection outbreak of Candida albicans bloodstream infection is fever. The use of caspofungin and amphotericin B in children with azole and 5-fluorocytosine resistance may obtain better therapeutic effect.