Hu Ya, Yu Jia-lin, Li Lu-quan
Department of Neonatology, Children's Hospital of Chongqing Medical University, Chongqing 400014, China.
Zhonghua Er Ke Za Zhi. 2007 Jun;45(6):442-5.
In recent years, the incidence of fungal infection in neonates has been risen year by year, but there are no widely accepted criteria to identify the clinical significance of the culture results of secretion from lower respiratory tract at present. The aim of the present study was to understand the clinical value and risk factors of fungal infections as suggested by sputum culture in neonates, which may help clinicians to diagnose and treat the neonates with fungal infection of respiratory tract.
One hundred and forty nine neonates with positive sputum culture results and suffered from pneumonia hospitalized from October, 2002 to May, 2005 in Children's Hospital of Chongqing Medical University were analyzed. The cases were divided into three groups according to the results of sputum culture. Forty cases who were only fungus positive were enrolled into the fungal group, 30 cases who were positive for both fungus and bacteria were classified into the mixed group, and the remaining 79 cases who were positive for bacteria only were recruited into bacterial group. Several clinical characteristics of neonates from the three groups were compared retrospectively. t test, chi-square test and Logistic regression analysis were used for statistical analyses.
Seventy of the 149 patients (47.0%) had fungal infections. Candida was the main genus cultured from sputum. Rate of resistance to fluconazole was 25.7% (9/35). Candida albicans was the most common strain, which was found in 56.9% of cases whose sputum culture was positive for fungi. In fungal group (n = 40), mixed group (n = 30) and bacterial group (n = 79), white blood cell count were (10.3 +/- 3.5) x 10(9)/L (11.7 +/- 5.2) x 10(9)/L and (14.4 +/- 10.5) x 10(9)/L, respectively, F = 3.78, P = 0.03, with neutrophil count (5.1 +/- 3.3) x 10(9)/L, (7.4 +/- 4.7) x 10(9)/L and (9.0 +/- 7.4) x 10(9)/L, respectively, F = 5.50, P = 0.01. Ratios of risk factors were as follows:for preterm infant, 32.5% (13/40), 20% (6/30) and 12.7% (10/79), chi(2) = 6.68, P = 0.04; for antepartum glucocorticoid used, 10.0% (4/40), 6.7% (2/30) and 0% (0/79), P = 0.01; for trilogy of antibiotics used, 10.0% (4/40), 16.7% (5/30) and 2.5% (2/79), P = 0.02; for therapy with carbapenems (Carbenin or Tienam), 32.5% (13/40), 63.3% (19/30) and 17.7% (14/79), chi(2) = 21.26, P = 0.00. There was significant difference among the three groups in the above factors respectively. Using the sputum culture results with or without fungus as the dependent variable, multivariate logistic regression showed that preterm infant (X(1)) and the therapy with carbapenems (X(2)) suited the best regression equation: Logistic (SCF) = beta(0) (0.12) + 1.63X(1) + 1.20X(2) (chi(2) = 43.04, P < 0.05).
Fungal growth in sputum culture in the neonates with pneumonia was common, Candida was the main genus, and Candida albicans was the most common one. Prematurity and the therapy with carbapenems were the most important independent risk factors associated with fungal growth in culture of sputum specimen from neonates.
近年来，新生儿真菌感染的发生率逐年上升，但目前尚无广泛认可的标准来确定下呼吸道分泌物培养结果的临床意义。本研究旨在了解新生儿痰培养提示的真菌感染的临床价值及危险因素，以帮助临床医生诊断和治疗呼吸道真菌感染的新生儿。
对2002年10月至2005年5月在重庆医科大学附属儿童医院住院的149例痰培养结果阳性且患肺炎的新生儿进行分析。根据痰培养结果将病例分为三组。仅真菌阳性的40例纳入真菌组，真菌和细菌均阳性的30例分为混合组，其余仅细菌阳性的79例纳入细菌组。回顾性比较三组新生儿的若干临床特征。采用t检验、卡方检验和Logistic回归分析进行统计学分析。
149例患者中有70例（47.0%）发生真菌感染。念珠菌是痰中培养出的主要菌属。对氟康唑的耐药率为25.7%（9/35）。白色念珠菌是最常见的菌株，在痰培养真菌阳性的病例中占56.9%。真菌组（n = 40）、混合组（n = 30）和细菌组（n = 79）的白细胞计数分别为（10.3±3.5）×10⁹/L、（11.7±5.2）×10⁹/L和（14.4±10.5）×10⁹/L，F = 3.78，P = 0.03，中性粒细胞计数分别为（5.1±3.3）×10⁹/L、（7.4±4.7）×10⁹/L和（9.0±7.4）×10⁹/L，F = 5.50，P = 0.01。危险因素的比例如下：早产儿，分别为32.5%（13/40）、20%（6/30）和12.7%（10/79），χ² = 6.68，P = 0.04；产前使用糖皮质激素，分别为10.0%（4/40）、6.7%（2/30）和0%（0/79），P = 0.01；使用三联抗生素，分别为10.0%（4/40）、16.7%（5/30）和2.5%（2/79），P = 0.02；使用碳青霉烯类（亚胺培南或美罗培南）治疗，分别为32.5%（13/40）、63.3%（19/30）和17.7%（14/79），χ² = 21.26，P = 0.00。上述因素在三组间分别有显著差异。以痰培养有无真菌结果为因变量进行多因素Logistic回归分析显示，早产儿（X₁）和使用碳青霉烯类治疗（X₂）最适合回归方程：Logistic（SCF） = β₀（0.12） + 1.63X₁ + 1.20X₂（χ² = 43.04，P < 0.05）。
肺炎新生儿痰培养中真菌生长常见，念珠菌是主要菌属，白色念珠菌最常见。早产和使用碳青霉烯类治疗是与新生儿痰标本培养中真菌生长相关的最重要独立危险因素。
