新生儿侵袭性真菌感染

来源 :中国小儿急救医学 | 被引量 : 0次 | 上传用户:lsh01015
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侵袭性真菌感染(invasive fungal infection,IFI)是早产儿致死和致残的重要原因。新生儿IFI的发生涉及宿主因素(如超未成熟早产儿、极低出生体重、免疫功能低下、真菌定植等)与外在因素(如中心静脉置管、机械通气、肠外营养、广谱抗生素应用等)。新生儿IFI临床表现无特异性,容易与晚发型细菌败血症混淆,血小板减少和高血糖是其重要特征。G试验和PCR对真菌感染诊断有一定价值。新生儿IFI重在预防,综合性预防措施如切断传播途径、加强医疗管理至关重要,氟康唑预防性应用需考虑所在NICU真菌感染发生率及高危因素而定。当存在IFI的临床特征及高危因素时,应及时经验性抗真菌治疗;病原菌明确后采用靶向治疗;新生儿IFI管理中,须关注中枢神经系统感染及生物膜问题。“,”Invasive fungal infection (IFI) is one of the main causes of death and disability in premature infants.The occurrence of neonatal IFI involves host factors (such as extreme prematurity, very low birth weight, immature immune system, and fungal colonization, etc.) and external factors (such as central venous catheterization, mechanical ventilation, parenteral nutrition, and broad-spectrum antibiotic application, etc.). The clinical manifestations of IFI in neonates are nonspecific, which is easily confused with late-onset bacterial sepsis.Thrombocytopenia and hyperglycemia are important features of IFI.G-test and PCR have certain values in the diagnosis of fungal infection.The neonatal IFI should be mainly focused on its prevention.It is crucial for neonatal IFI to take comprehensive preventive measures such as cutting off transmission routes and strengthening medical management.The incidence of fungal infection and high risk factors in NICU where it is located should be considered when using the fluconazole prophylactically.Empirical antifungal treatment should be commenced promptly when a high degree of suspicion for IFI exists based on the presence of specific clinical features and risk factors.Targeted therapy means administer antifungal drugs on the basis of isolation of fungal.In addition, more attention should be given to the issues regarding central nervous system infection and biofilm in the management of neonatal IFI.
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