氟康唑和伏立康唑治疗新生儿近平滑假丝酵母菌败血症的临床分析

Efficacy of fluconazole and voriconazole in treatment of neonatal candida parapsilosis sepsis

关键词:  婴儿  新生  败血症  近平滑假丝酵母菌  氟康唑  伏立康唑

Key words:  infant  newborn  sepsis  Candida parapsilosis  fluconazole  voriconazole

摘要:

目的探讨氟康唑和伏立康唑治疗新生儿近平滑假丝酵母菌败血症的临床效果，为该类患儿临床抗真菌药物的选择提供参考。方法回顾性分析2014—2018年收治新生儿近平滑假丝酵母菌败血症55例的临床资料，根据首选治疗药物分为首选氟康唑组（31例）和首选伏立康唑组（24例）。比较两种药物初始治疗显效比例、以及并发中枢感染在内的治愈患儿整体疗程和病死率。结果首选氟康唑组： 治愈28例，疗程为（31.39±12.40） d；其中15例治疗（6.67±2.19） d后血培养转阴，疗程（23.13±2.72） d；其余13例治疗至14 d血培养仍持续阳性，换为伏立康唑治疗（需挽救治疗）（6.31±2.21） d后血培养转阴，（25.38±10.20） d后痊愈，疗程（氟康唑+伏立康唑治疗疗程）为（40.15±11.31） d。死亡1例，放弃2例，病死率9.68%。首选伏立康唑组： 24例均治愈无死亡病例；治疗（7.83±2.41） d后血培养转阴（2周内转阴为治疗初始显效），治疗初始显效比例高于首选氟康唑组（χ2=6.469，P＜0.01）；疗程为（25.83±5.55） d，短于首选氟康唑组治愈患者疗程（t=2.136，P<0.05）。两组治愈患者中均未发现药物相关副作用。结论首选伏立康唑可能较氟康唑更适合新生儿近平滑假丝酵母菌败血症的治疗，但其有效性和安全性仍需进一步明确。

Abstract:

ObjectiveTo investigate the clinical effect of fluconazole and voriconazole in the treatment of neonatal candida parapsilosis sepsis（NCPS). MethodsFifty-five cases of NCPS were enrolled from January 2014 to December 2018, including 31 cases treated with fluconazole（fluconazole group) and 24 cases treated with voriconazole（voriconazole group). The efficacy of drug treatment was compared between the two groups. ResultsIn fluconazole group the blood culture was converted to negative after（6.67±2.19) d in 15 cases and the treatment course was（23.13±2.72) d; the blood culture remained positive after 14 d of treatmentin in another 13 cases, then the drug changed to voriconazole, the blood culture was converted to negative after（6.31±2.21) d， and patients were cured after（25.38±10.20) d with a total course（fluconazole+voriconazole） of（40.15±11.31) d; finally 28 cases were cured with a average course of（31.39±12.40) d; 3 patients died（including 2 cases of abandoning treatment) with a fatality rate of 9.68%. In voriconazole group all patients were cured and no death occurred; the blood culture turned negative after（7.83±2.41) d with a total course of（25.83±5.55) d, which was shorter than that of fluconazole group（t=2.136, P<0.05). Compared to voriconazole group all cases were improved after initial treatment in fluconazole group（χ2=6.469, P<0.01). No side effect was observed in all 52 survivors of two groups. ConclusionVoriconazole may be preferable than fluconazole in initial treatment for NCPS patients, but its efficacy and safety need to be further confirmed.