氟康唑预防极早产儿/极低出生体重儿晚发型侵袭性真菌感染的作用:一项基于倾向评分匹配的回顾性队列研究OA
Efficacy of fluconazole prophylaxis for late-onset invasive fungal infection in very preterm infants/very low birth weight infants:a retrospective cohort study based on propensity score matching
目的 评估在晚发型侵袭性真菌感染(invasive fungal infection,IFI)发生率极低的新生儿重症监护病房中,极早产儿/极低出生体重儿常规预防性使用氟康唑的必要性,为临床应用提供参考.方法 对2018年1月—2023年12月于四川大学华西第二医院和四川省儿童医院新生儿重症监护病房住院的、符合纳入排除标准的极早产儿/极低出生体重儿进行回顾性倾向评分匹配研究.根据是否使用氟康唑预防IFI分为氟康唑组和非氟康唑组,主要结局指标为晚发型IFI的发生率.结果 共纳入1 961例患儿,晚发型IFI发生率为0.25%(5/1 961).经倾向评分匹配后,氟康唑组和非氟康唑组各纳入442例.氟康唑组与非氟康唑组的晚发型IFI发生率(0.45%vs 0.23%)、病死率(2.04%vs 0.90%)、需手术治疗的早产儿视网膜病变发生率(6.11%vs 4.98%)、≥2级脑室内出血发生率(9.28%vs 6.56%)、≥2期坏死性小肠结肠炎发生率(10.18%vs 8.14%)、支气管肺发育不良发生率(36.20%vs 36.88%)以及住院时间(48.5 d vs 50.5 d)比较,差异无统计学意义(P>0.05).结论 在晚发型IFI发生率极低的新生儿重症监护病房中,不推荐极早产儿/极低出生体重儿常规使用氟康唑预防晚发型IFI.
Objective To evaluate the necessity of routine fluconazole prophylaxis in very preterm infants/very low birth weight(VLBW)infants in neonatal intensive care units(NICUs)with a very low incidence of late-onset invasive fungal infection(IFI),and to inform clinical practice.Methods A retrospective cohort study using propensity score matching was conducted including eligible very preterm infants/VLBW infants admitted to the NICUs of West China Second Hospital,Sichuan University and Sichuan Provincial Children's Hospital from January 2018 to December 2023.Infants were categorized into fluconazole and non-fluconazole groups according whether they received fluconazole prophylaxis.The primary outcome was the incidence of late-onset IFI.Results A total of 1 961 infants were enrolled,with an overall late-onset IFI incidence of 0.25%(5/1 961).After propensity score matching,442 infants were included in each group.No statistically significant differences were observed between the fluconazole and non-fluconazole groups in the incidence of late-onset IFI(0.45%vs 0.23%),mortality(2.04%vs 0.90%),retinopathy of prematurity requiring surgery(6.11%vs 4.98%),intraventricular hemorrhage grade≥2(9.28%vs 6.56%),necrotizing enterocolitis stage≥2(10.18%vs 8.14%),or bronchopulmonary dysplasia(36.20%vs 36.88%),nor in length of hospital stay(48.5 days vs 50.5 days)(all P>0.05).Conclusions In NICUs with a very low incidence of late-onset IFI,routine fluconazole prophylaxis is not recommended for very preterm infants/VLBW infants.
黄方俊;应俊杰;李小洪;唐军;何洋;张萌;熊涛;夏斌;李明玉;王华;石晶;张莉
四川大学华西第二医院新生儿科,四川 成都 610041出生缺陷与相关妇儿疾病教育部重点实验室,四川 成都 610041中国出生缺陷监测中心(四川大学华西第二医院),四川 成都 610041四川大学华西第二医院新生儿科,四川 成都 610041||出生缺陷与相关妇儿疾病教育部重点实验室,四川 成都 610041四川大学华西第二医院新生儿科,四川 成都 610041四川大学华西第二医院新生儿科,四川 成都 610041四川大学华西第二医院新生儿科,四川 成都 610041四川省儿童医院新生儿科,四川 眉山 620000四川省儿童医院新生儿科,四川 眉山 620000四川大学华西第二医院新生儿科,四川 成都 610041四川大学华西第二医院新生儿科,四川 成都 610041四川大学华西第二医院新生儿科,四川 成都 610041
侵袭性真菌感染氟康唑新生儿重症监护病房极早产儿极低出生体重儿
Invasive fungal infectionFluconazoleNeonatal intensive care unitVery preterm infantVery low birth weight infant
《中国当代儿科杂志》 2026 (8)
928-934,7
国家重点研发计划(2024YFC2707700)四川省自然科学基金面上项目(2025ZNSFSC0693).
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