Clinical Characteristics,Prognostic Analysis And Therapy Of Candidemia In Neonates After Abdominal Surgeries

Objective: To investigate the clinical characteristics,prognostic variables and therapy of candidemia in neonates after abdominal surgeries.Methods: 44 cases of candidemic patients undergoing abdominal surgeries in the first affiliated hospital of anhui medical university from Mar 2005 to Sep 2015 were retrospectively reviewed.According to the clinical outcome of children can be divided into survival group and death group,analysis and comparison the difference of them from clinical characteristics,etiology characteristics,the experimental results,clinical risk factors.Clinical date were collected and prognostic factors were analyzed by multivariable Logistic regression.Results: Among the 44 candidemic patients the case fatality rate was36.4%.Compared between survival patients and death patients age(t=-2.651),long time in ICU(t=-2.238),broad-spectrum antibiotics time(t = 5.063),mechanical ventilation(X~2=4.490),abdominal cavity drainage tube time(X~2=4.243),total parenteral nutrition(X~2=4.849),combination of sepsis and septic shock(X~2=9.617、X~2=9.617),hypoalbuminemia(t=3.512)、anemia(t=2.442)、thrombocytopenia(t=9.821)was statistically significant(P < 0.05).The most common pathogens were C.albicans,C.tropicalis and C.parapsilosis.The resistant rate to fluconazole was 50%.Prophylactic/empirical antifungal therapies were carried out in 26 cases was statistically significant(P < 0.05).Compared between survival patients and death patients there was no statistical significance in the resistant rate to fluconazole.The nalysis of prognostic factors showed that the outcome was better when patients received non-triazole agents.43 cases(97.7%)with 1.3-β-D test(G test)positive.It was more sensitive and specific than blood culture for early diagnosis of invasive fungal infection(P<0.05).Compared with survivals patients who died were comparatively of long time in ICU、hypoalbuminemia、anemia、thrombocytopenia、liver dysfunction、long time of total parenteral feeding and broad spectrum antibiotic use.Lower percentage were taken by prophylactic/empirical antifungal therapy.By multivariable regression analysis,septicopyemia,total parenteral feeding and without anti-fungal treatment were factors independently associated with death.Prophylactic/empirical antifungal therapy was found to be the only protective factor of death.Conclusions: The mortality of candidemia in neonates after abdominal surgeries is high,through serological test results and clinical risk factors can early recognition and disgnosis.Prophylactic/empirical antifungal therapy was found to be the only protective factor of death.It is necessary to switch to amphotericin Bor echinocandin therapy when patients are resistant to fluconazole.