The Incidence of Systemic Fungal Infection Associated With Central Venous Catheter at Neonatal Intensive Care Unit in Ain Shams Pediatric Hospital

Abstract

Back ground I nvasive funga1 infections in infants and neonates, especially in NICUs, are a problem in clinical treatment and they are accompanied with a high mortality (Brissaud et a1., 2012). CVCs are widely used in NICUs. They provide an intravenous route for the safe administration of fluids and medications (Menon, 2003). The major risk factor for invasive Candidasis and Candidaemia is use of invasive devices as central venous catheters. They cause break in the skin and mucosal integrity, which predisposes these sites for colonization and infection by Candida (sardana et al., 2012). Aim of work In the present stud we aimed to detect the rate of systemic fungal infection associated with central venous catheters as CVCs. We also aimed to assess the risk factors of fungal infection and the effect of empirical antifungal treatment on the neonates admitted at NICU.

Patients and methods All patients were subjected to: History taking and examination included; gestational age, sex, weight, age, cause of admission, exposure to hypoxia, temperature, heart rate and receiving of empirical antifungal treatment. The following investigations were done: • Complete blood count with differential leucocytic count. • C-reactive protein quantitative count. • Bacterial blood culture. • Fungal culture: (50%) the samples for fungal culture were blood drawn from peripheral veins and the other 50% the samples were blood drawn from the lumen of CVCs, and were cultured on Sabouraud Dextrose Agar (SDA) for detection of fungal growth.

Results The results of our study reported the following:  The studied cases were 73 males and 47 females, their gestational ages ranged between 28 weeks and 41 weeks. 50% of cases were admitted due to chest diseases.  88.3% have positive bacterial infection. The most common organism is Klebsiella (49.1%) followed by staphylococci (28.3%).  The incidence of fungal infection at neonates with CVCs was 65%.  Non-significant differences in the incidence of fungal infection and sex, age, Gestational Age, weight, diagnosis and heart rate.  Non-significant correlation between the fungal infection and CRP, total leucocytic count, granulocytes, lymphocytes, platelets count and the hemoglobin level.  Highly significant correlation between fungal infection and decrease in body temperature < 36 ºc (P value < 0.001).  Significant correlation between exposure to hypoxia and the incidence of fungal infection (P value 0.032).  Significant correlation between the incidence of fungal infection and the duration of CVCs insertion (P value 0.042). Incidence of fungal infection increases with the duration of CVCs insertion (more than 1 week).  The fungal culture results were more positive with the blood samples drawn from CVCs (71.8%) than cultures with the blood drawn percutaneously from a peripheral vein (28.2%) with statistically highly significant difference (P-value < 0.001).  Strong positive highly statistically significant correlation between receiving empirical antifungal treatment and discharge (P value 0.000).