Objective: To investigate the clinical features of invasive pulmonary fungal infections (IPFIs) after biliary atresia (BA) surgery and related risk factors.
Methods: A retrospective analysis was performed for the clinical data of 49 children with IPFIs after BA surgery, including clinical features, lung imaging findings, and pathogenic features. The risk factors for IPFIs after BA surgery were also analyzed.
Results: The most common pathogens of IPFIs after BA surgery was Candida albicans (17 strains, 45%), followed by Candida tropicalis (7 strains, 18%), Aspergillus (6 strains, 16%), Candida krusei (3 strains, 8%), Candida glabrata (3 strains, 8%), and Candida parapsilosis (2 strains, 5%). Major clinical manifestations included pyrexia, cough, and shortness of breath, as well as dyspnea in severe cases; the incidence rate of shortness of breath reached 78%, and 35% of all children had no obvious rale. The multivariate logistic regression analysis showed that age at the time of surgery, time of glucocorticoid application, cumulative time of the application of broad-spectrum antibiotics, and recurrent cholangitis were major risk factors for IPFIs after BA surgery.
Conclusions: The three most common pathogens of IPFIs after BA surgery are Candida albicans, Candida tropicalis, and Aspergillus. It is important to perform surgery as early as possible, avoid recurrent cholangitis, and shorten the course of the treatment with broad-spectrum antibiotics and glucocorticoids for decreasing the risk of IPFIs.
目的: 分析胆道闭锁（BA）患儿术后并发侵袭性肺部真菌感染（IPFIs）的临床特点及主要危险因素。
方法: 回顾性研究49例BA术后合并IPFIs患儿的临床、肺部影像学及病原学特点。并进行BA术后合并IPFIs的危险因素分析。
结果: BA患者术后合并IPFIs感染的病原菌依次为白色念珠菌17株（45%）、热带念珠菌7株（18%）、曲霉菌6株（16%）、克柔念珠菌3株（8%）、光滑念珠菌3株（8%）、近平滑念珠菌2株（5%）。主要表现为发热、咳嗽及气促，严重者呼吸困难，其中气促的发生率达78%，35%的患儿无明显啰音。多因素logistic回归分析显示：手术年龄、糖皮质激素使用时间、广谱抗生素累积使用时间、胆管炎反复发作是BA术后IPFIs的主要危险因素。
结论: BA患者术后合并的IPFIs前三位病原菌为白色念珠菌、热带念珠菌和曲霉菌。尽早手术、避免反复发作的胆管炎、缩短抗菌药及糖皮质激素的疗程可以减少发生IPFIs的风险。