Clinical analysis and drug resistance research of pulmonary fungal infection among children with severe diseases in pediatric intensive care unit

Objective To investigate the prevalence of pulmonary fungal infection and drug resistance of the pathogenic fungi among children with severe diseases in pediatric intensive care unit(PICU). Methods From July 2013 to June 2017, the complete clinical data, results of fungal culture and drug sensitivity of bronchoalveolar lavage fluid in 112 critically ill children with pulmonary fungus infection of PICU hospitalization in our hospital were collected.Samples of peripheral venous blood were collected meantime, including blood routine examination, C reactive protein, G test and GM test. Results One hundred and twenty-six fungi were isolated from sputum samples in 112 critically ill children.Severe pulmonary infection(30.36%, 34/112) was the most common form of the primary diseases, the next were severe sepsis(16.07%, 18/112)and severe malnutrition(15.18%, 17/112). Classified based on age difference, the first one was <1 year old (43.75%, 49/112), the second one was 1 to 3 years old(29.46%, 33/112). The fungal strains were predominantly Candida albicans (61.90%) and Candida tropicalis (16.67%), among the infectious cases 14 were diagnosed as mixed infection.Two cases of 3 cryptococcal infectious children were HIV infection, another one was malignant tumor, Cryptococcus was cultured in both sputum, pleural effusion and cerebrospinal fluid.The drug resistance rate of fluconazol in 126 strains of fungi was 12.70%, the rate of itraconazole was 7.14%.Generally, the fungi cultured were with very low resistance to 5-fluorocytosine, voriconazole and amphotericin B. However, the strains of Aspergillus fumigates, Candida kruse, Candida parapsilosis and Cryptococcus were highly resistant to fluconazol and itraconazole, but with very low resistance to 5-fluorocytosine and amphotericin B. Conclusion Candida albicans is the main pathogenic fungus of pulmonary fungal infection among children in PICU, and we could choose voriconazole and amphotericin B as treatment of critically ill children with pulmonaty fungal infection. Key words: Pediatric intensive care unit; Pulmonaty fungal infection; Drug resistance; Critically ill