13 cases of fungal sepsis in premature infants

Abstract

Objective To study the clinical characteristics, pathogen distribution, drug sensitivity test, and therapeutic effect of fungal sepsis in preterm infants in neonatal intensive care unit (NICU), and provide some evidences for its prevention, early diagnosis, and treatment. Methods A total of 13 premature infants diagnosed with fungal sepsis in our department from January, 2013 to January, 2018 were enrolled. The risk factors, clinical features, etiology, and drug sensitivity test were analyzed. Results 13 cases of premature infants with fungal sepsis’ gestational age was 26-35 weeks, and their birth weight 700-2 650 g. All the 13 cases empirically took broad-spectrum antibiotics and total parenteral venous nutrition; 7 cases took mechanical ventilation; and 11 cases took deep venous catheter (PICC, CVC). The clinical manifestations included frequent apnea, poor response, gastric retention, abdominal distension, hypothermia, fever, poor perfusion, and other symptoms. The whole blood leukocytes was <4×109 in 3 cases, and platelets <100×1012 in 3cases; CRP increased 10 cases; fungal G test (plasma 1,3-β-D glucan) were significantly increased in 11 cases, reaching 113.3 to 677.1 pg/ml); all the cases got Candida infection, including 11 cases of Candida albicans and 2 cases of Candida parapsilosis. The sensitivity of drug sensitivity test to fluconazole (Da Fukang) was 92.3% (12/13), and that to voriconazole 100.0% (13/13), and that to amphotericin 100.0% (13/13). 12 cases were cured and discharged, and 1 case gave up the treatment. Conclusion Fungal sepsis in premature infants is mainly caused by Candida infection; it is lack of specific manifestations, and associates with decreased white blood cells and platelets, increased CRP, and increased fungal G test; better prevention and early active treatment is effective. Key words: Premature infants; Fungal infections; Sepsis