Risk Factors And Clinical Analysis For Invasive Fungal Infection In Neonatal Intensive Care Unit Patients

Background:In recent years,nasocomial infection rate in neonatal intensive care unit(NICU) increased gradually. Neonatal fungal infection(IFI) become more and more common along with both the development of perinatal medical technology and a significant increase in the survival of preterm infants, especially those VLBW infants. Many risk factors for the development of IFI in neonates have been identified as follows:using of catheters of central and peripheral vessels, widespread using of broad spectrum antibacterical medications, prolonged mechanical ventilation, prolonged parenteral nutrition, glucocorticosteroid therapy.The clinical presentation of invasive fungal and bacterial infection is similar. This may cause diagnostic delay. Diagnosis and treatment maybe farther delayed because of difficulty in culturing the organisms from blood, cerebrospinal fluid or urine.Giving the high mortality and the difficulty in establishing an early diagnosis, datas to inform decisions about the evaluation and use of antifungal infection control strategies are needed. Objective:We retrospectively reviewed the medical charts of recent 7 years analysis the clinical feature, treatment, prognosis, then compared their data with those of 90 matched control neonatal infants who did not have IFI to determine independent risk factors of IFI.Materials and Methods:The medical charts of all 5135 N1CU admissions in the past 7 years between Jan.2004-Dec.2010 were reviewed,45 neonates were detected with IFI. Two controls, matched by MA, BW category; hospital date, ward; hospital stay, admission.(?),were selected for each case. SPSS 13.0 were used to analysis those two groups' datas to detect independent risk factors for IFI in neonates. Besides, we also collected basic illness, clinical signs of IFI, laboratory characteristics, catergry of fungal. strategy for treatment.Results:IFI was defined as according to cinical signs of neonatal sepsis and isolation of fungi in one or more of the following sites:bloodstream, urine or cerebrospinal fluid(CSF). Blood cultures were all drawn from femoral vein puncture, urine cultures were drawn via percutaneous suprapubic aspiration. Care was taken to avoid obtaining blood or urine cultures through an area with active mucoepithelial candidasis. All cases has some different sighs:feeding intolerance(48.9%). hyperthermia(46.7%). apnea(46.7%) and reaction delay(44.4%) were most common presenting signs. About 88.9% of case infants had platelet(PLT) decrease, bout 91.9% had light or middle, even highly c-reactive protein (CRP) increased, about 71.1% IFI infants had normal white blood count(WBC) level. In 41/45 of the infants, fungi grew in the bloodstream, in 3 of the case patients fungi grew in the CSF, in 2 of the case patients fungi grew in the urine with 102CFU. Cadida parapsilosis was the leading causative pathogen of IFI, and was isolated in 33.3% of the patients, Calbicans was the causative organism of 22.2% of the patients, respectively. Conditional Bivarirate logistic regression modeling defined broad spectrum antibiotics(%), central catheter placement, mechanical ventilation>2d, abdominal surgery, neutropenia within 7 days of age were exposures significantly associated with case status.Conclutions:1.The predominat factors identified were being on broad spectrum antibiotics, central catheter placement, mechanical ventilation>2d, abdominal surgery, neutropenia within 7 days of age.2.PLT decrease. CRP increased were most common laboratory foundings, and a normal WBC count does not rule out IFI.3.Candida parapsilosis was the leading causative pathogen of IFI in neonates, Calbicans was the next.