Fungaemia in the neonatal unit at Chris Hani Baragwanath Hospital: risk factors, aetiology, susceptibility to antifungals and outcome.
Year: 2012
Type: dissertation
Study design: Observational Study
Abstract: Aim \nThe aim was to determine the epidemiology of invasive fungal infections at Chris \nHani Baragwanath Hospital. The specific objectives were to determine the 1) risk \nfactors, 2) clinical presentation, 3) laboratory abnormalities, 4) organisms and their \nsusceptibilities and 6) outcome in neonates with positive blood or CSF fungal \ncultures at Chris Hani Baragwanath Hospital. \nMethods \nThis was a retrospective record review of patients who had positive blood or CSF \ncultures. Patients were identified by a computerized microbiological surveillance \ndatabase. The data was collected over a three-year period from January 2002 to \nDecember 2004. Patient hospital files were reviewed for clinical signs, full blood \ncount (FBC), C-reactive protein (CRP) and outcomes. Fungal culture results were \nreviewed for susceptibilities. To identify risk factors a convenient cohort was \ncompared to the patients with fungal sepsis. The data was analysed using a \nStatistica software package. \nResults \nThere were 150 patients with fungal sepsis among admissions over this 3 yearperiod \ngiving an incidence of 1.3 per 100 admissions. Thirty-nine records were not \nfound thus 111 patient records were reviewed. The median birthweight was 1280g and the gestational age 30 weeks. The median age of onset was 16 days and \n6.3% had early onset fungal sepsis. There were 61 males. Twenty-eight percent of \npatients were born to HIV positive mothers. Candida parapsilosis was the \ncommonest (56%) organism isolated followed by C. albicans (43%). All the C. \nalbicans isolates and 93% of the C. parapsilosis isolates were susceptible to \namphotericin B. Fluconazole susceptibilities were reported as, 96% for C. \nalbicans, and 60% of the C. parapsilosis as being susceptible. Central venous \ncatheters (CVCs) (p=<0.001), the use of TPN (p=<0.001) and third generation \ncephalosporins were identified as risk factors associated with fungal sepsis. The \nall-cause mortality and Candida–related mortality were 30% and 23% \nrespectively. The non-survivors had lower platelet counts (p=0.007) than the \nsurvivors. Patients with Gram-negative sepsis had lower platelet counts than the \nfungal group (p=<0.001) on the repeat laboratory parameters. \nConclusion \nThe incidence is 1.3 per 100 admissions. Risk factors associated with fungal \nsepsis are very low birthweight and gestational age, the use of TPN, CVCs and \nthird generation cephalosporins. Candida parapsilosis is the common organism \ncausing fungal sepsis in neonates. Candida albicans was associated with a higher \nmortality. Thrombocytopenia is not organism specific to fungal sepsis.
Author: Firdose Nakwa
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2120108664