ABSTRACT
Objective To investigate the clinical features of fungal sepsis in premature infants.Methods The risk factors,clinical characteristics,laboratory findings,treatment and prognosis of 30 preterm infants with fungal sepsis in neonatal intensive care unit of the First Mfiliated Hospital of Anhui Medical University from Jan.2010 to Dec.2012 were analyzed.Results Fourteen cases (46.7％) were extremely preterm infants.The gestational ages of 20 cases(66.7％) were less than 34 weeks.The preterm infants were infected with fungal sepsis at the age of 6-42 d,and the mean age was (15.70 ± 9.02) d.The most common pathogens were Candida albicans (83.3％) and Candida glabrata(13.3％).Before infection,6 cases accepted the endotracheal intubation and mechanical ventilation,9 cases accepted Peripherally Inserted Central Catheter with the duration more than or equal to 7 days,and 5 cases accepted multi-antibiotic treatment with the duration more than or equal to 14 days,with the main clinical manifestations including poor response in 25 cases (83.3％),poor feeding in 25 cases (83.3％),and blood oxygen concentration decrease in 20 cases (66.7％).There were 27 cases(90.0％) with the increased C-reactive protein(CRP),5 preterm infants with the white blood cell count less than 5.0 × 109/L,5 patients with the white blood cell count more than 15.0 × 109/L,and 20 cases (66.7 ％) with thrombocytopenia.Among those 30 cases,2 cases (6.7 ％) abandoned therapy,4 cases (13.3％) accepted liposomal amphotericin B because of the poor efficacy to fluconazole,and 24 cases (80.0％) accepted fluconazole.Of the 28 cases,4 cases(13.3％) were improved,24 cases(80.0％) were cured and no one died.Conclusions The proportion of Candida albicans species increased during the cause of fungal sepsis in premature infants.It was probably the cause of fungal sepsis when preterm infants had poor response,poor feeding,blood oxygen concentration decrease in 2-3 weeks after birth.Possible strategies were recommended including strict aseptic manipulation,rational use of antibiotics,antifungal prophylaxis for preterm infants who have risk factors in highoccurrence season in order to decrease the morbidity and mortality of neonatal fungal sepsis.