21 Cases Of Clinical Analysis Of PICU Invasive Fungal Bloodstream Infection

Objective: In recent years,because of the long-term use of broad-spectrum antibiotics,glucocorticoids,immunosuppressant,and the increase of ventilator and iatrogenic invasive operation,the incidence of fungal infection is increasing,and the death caused by it is also increasing.As the disease lacks of specific manifestations in the early stage,and the low positive rate of fungal culture,leading to the diagnosis delayed,so that the early and effective treatment can't be carried out,resulting in an increase in the mortality rate.By summarizing the data of the high risk factor and the clinical manifestation,etc.of IFI,the purpose of this paper is to improve the understanding of the IFI,and to play a guiding role in early diagnosis and treatment and positive improvement of prognosis.Method: By choosing 21 children as the research objects,who were diagnosed as the IFI bloodstream infection hospitalized in Sheng Jing Hospital affiliated to China Medical University from January 2012 to January 2018,retrospectively analyzed the clinical characteristics,high risk factors and prognosis of the research objects.Result: There was no significant correlation between the incidence of fungal infection and age and sex in 21 children with IFI bloodstream infection.Candida albicans and Candida parapsilosis was the leading pathogen,and the mortality rate of Candida parapsilosis was high(80%).For the 21 children with IFI bloodstream infection,the mortality rate was as high as 61.9% with 28 days' following research.The protopathy was mainly respiratory system disease(14.29%),digestive system disease(23.81%).Among them,4 cases of severe pneumonia,4 cases of gastrointestinal perforation.The high risk factors were mainly combined use of broad-spectrum antibiotics,invasive operation(tracheal intubation,central venous catheterization,catheterization and indwelling stomach tube,etc.),long-term hospitalization of ICU and so on,all above 85%.Apart from that,lower humoral immunity(19.05%)and the use of immunosuppressant(19.05%),glucocorticoids(28.57%)and intravenous nutrition(52.38%)also created a convenient condition for fungal infection.Fungal infection is characterized by atypical fever(80.95%),white blood cells abnormal rise or decrease(47.62%),CRP polyreactivity increase(80.95%),the positive rate of G test could reach 42.86%.In the survival group include 8 cases of children,75% before diagnosed with fungal infection were treated with antifungal treatment,and the mortality rate was 53.85%,and the rate of preventive drug use was 53.85% for the death group.Conclusion: Long-term hospitalization of ICU,long-term and combined use of a large amount of broad-spectrum antibiotics,invasive operation,autoimmune deficiency and other factors increased the risk of fungal infection,and finding atypical refractory infection based on clinical primary diseases.In order to improve the excitatory foci of fungal infection and improve the related microbiological examination,the rate of early clinical diagnosis can be increased.After active intervention,the prognosis can be improved and the fatality rate can be reduced.