Analysis Of Clinical Characteristics And Risk Factors Of Fungal Septicemia In Very Low Birth Weight Infants

Objective:to analyze the clinical characteristics of fungal septicemia(FS)in very low birth weight infants((VLBWI))in recent 5 years,and to explore the risk factors of FS.Methods:The clinical data of VLBWI admitted within 72 hours after birth in(NICU)in Neonatal intensive Care Unit of Hunan Children's Hospital from January 1,2015 to December 31,2019 were collected retrospectively.the fungal positive blood culture was FS group,and the fungal negative blood culture was randomly selected as non-FS group according to the proportion of 1:3.The differences of clinical data between FS group and non-FS group were compared,and the clinical characteristics and risk factors of VLBWI fungal septicemia were analyzed.Results:1.A total of 388 cases of NICU were admitted within 72 hours after birth in our hospital from January 1,2015 to December 31,2019,and a total of 25 cases of FS occurred.The constituent ratio of FS was 6.44%.2.Among the 25 cases of FS,the most common pathogens were Candida parapsilosis(13 cases,52.00%),followed by Candida albicans(7cases,28.00%)and Candida tropicalis(2 cases,8.00%).3.In FS group,5 cases(20.00%)were resistant to fluconazole,all of them were non-Candida albicans.4.The average days of positive blood culture in FS group were(30.64±9.91)days after birth,and all of them were late-onset FS.5.The clinical manifestations of FS are atypical.The most common clinical manifestations are apnea and moderate to severe dyspnea.6.The abnormal rates of PH<7.35,PCO2<50mmHg,PO2<60mmHg,white blood cell count,platelet<100x10~9/L and C-reactive protein(CRP)in the FS group were significantly higher than those in the non-FS group,the difference was statistically significant(P<0.05);while the levels of globulin and albumin in the FS group were lower than those in the non-FS group,the difference was statistically significant(P<0.05).7.The length of hospital stays and the cost of hospitalization in FS group were significantly higher than those in non-FS group,the difference was statistically significant(P<0.05);The incidences of extrauterine growth restriction,hearing loss,severe bronchopulmonary dysplasia(BPD)and retinopathy of prematurity(ROP)in FS group were significantly higher than those in non-FS group,the difference was statistically significant(P<0.05).8.The birth weight and gestational age in the FS group were significantly lower than those in the non-FS group,the difference was statistically significant(P<0.05);and the proportion of gestational age<28weeks,PICC catheterization,invasive ventilator>2 days,carbapenem antibiotics,cefoperazone sulbactam,postpartum steroid therapy,gamma globulin and blood component transfusion(platelet,plasma or cryoprecipitation)in the FS group were significantly higher than those in the non-FS group,the difference was statistically significant(P<0.05);The duration of parenteral nutrition and PICC catheterization in FS group were significantly longer than those in non-FS group,the difference was statistically significant(P<0.05).9.Low globulin,long-term parenteral nutrition,use of carbapenem antibiotics and use steroids after birth are independent risk factors for FS in VLBWI.Conclusion:1.The incidence of fungal septicemia in VLBWI in recent 5 years was 6.44%.The most common pathogen was Candida albicans,followed by Candida albicans.2.VLBWI with FS has longer hospitalization time and higher hospitalization cost,and is more likely to have extrauterine growth retardation,hearing loss,severe BPD and ROP.3.Low globulin,long-term parenteral nutrition,use of carbapenem antibiotics and use steroids after birth are independent risk factors for FS in VLBWI.