| Background:In recent years,with the development of perinatal medicine,the survival rate of very low birth weight infants has been increasing,but the incidence of nosocomial infection in neonatal intensive care units has also increased year by year.Invasive fungal infection was associated with significant morbidity and mortality in neonates,especially very in low birth weight infants.Invasive fungal infection mainly occurred in premature infants under 32 weeks,but there were few studies on the large epidemiology of invasive fungal infection in very preterm infants.There was no epidemiological investigation of invasive fungal infection in very preterm infants.Objective:To analyze the incidence,distribution of pathogens,susceptibility factors and independent risk factors of fungal sepsis(FS)in the neonatal intensive care unit,and provide information for clinical prevention and treatment of fungal sepsis.Methonds:94 cases of very premature infants diagnosed as fungal sepsis from January 01,2009 to December 31,2017 were selected as the case group.The control group was selected according to the same gestational age range and hospitalization time in accordance with the ratio of 1:2,a total of 188 cases were selected.The pregnancy and maternal diseases and prenatal medications of the case group and the control group were counted separately(eg.gestational hypertension,prenatal),general conditions(eg.test-tube baby,amniotic fluid,umbilical cord,placental condition,neonatal respiratory distress syndrome),after hospitalization(eg.endotracheal intubation time,intravenous nutrition time).After January 01,2012,our hospital began to set up a very preterm babies ward,the divisions of our NICU were more specific and intravenous fluconazole was administered as a routine preventive measure for high-risk infants.Therefore,the case group is divided in two periods,from 2009 to 2011 as the fommer period,from 2012 to 2017 as the latter period,the research period also collected two periods of blood culture,blood culture positive date,blood culture positive fungal strains on common antifungal drug susceptibility results,etc.There were collected a total of 27 clinical indicators.Results:The incidence of FS in newborns was 0.24%(158/65914),and the incidence of FS in very preterm infants was 1.63%(94/5778),of which 73.4%(69/94)were very low birth weight/extremely low birth weight.The incedence of FS in the former period was 1.68%and the incidence of FS in the latter period was 1.61%.There was no significant difference between the two periods(x 2=0.035,P=0.852).The main pathogen of FS was Candida parapsilosis,account for 40.4%(38/94).,13 Risk factors were statistically significant.Logistic multiple regression analysiss showed placental abnormality(OR value:0.275),intravenous nutrition time(OR value:0.091),carbapenems use(OR value:7.313),endotracheal intubation time(OR value:1.111)were independent high risk factor.The incidence of FS in very premature infants was 1.63%(94/5778).The most common pathogen in very preterm infants was parapsilosis,accounting for 40.4%(38/94).Univariate analysis of case group and control group showed premature rupture of membranes,Premature rupture of membranes,vaginal delivery,abnormal placenta,neonatal respiratory distress syndrome,brochpulmory dysplayis,peripherally inserted central catheter,intravenous nutrition time,wide-spectrum antibiotic use time,endotracheal intubation time,oxygen inhalation time,Piperacillin tazobactam use,carbapenems use(meropenem or imipenem),time of carbapenems use.There were 13 risk factors,P values were less than 0.05,which were statistically significant.Logistic multiple regression analysis showed placental abnormality(OR value:0.275),intravenous nutrition time(OR value:0.091),carbapenems use(OR value:7.313),endotracheal intubation time(OR value:1.111)were independent high risk factor.The incedence of FS in the former period was 1.68%and the incidence of FS in the latter period was 1.61%.There was no significant difference between the two periods(x2=0.035,P=0.852).Conclusions:1.The FS incidence of very premature infants was 1.63%.Parapsilosis was the leading pathogen of FS in very preterm infants,accounting for 40.4%.2.Abnormal placenta,intravenous nutrition time,carbapenems use,and endotracheal intubation time were independent risk factors for fungal sepsis in very preterm infants.3.Fluconazole prophylaxis has no obvious effect on fungal sepsis in very premature infants. |
