Fungaemia in the neonatal unit at Chris Hani Baragwanath Hospital: risk factors, aetiology, susceptibility to antifungals and outcome.
Date
2012-01-17
Authors
Nakwa, Firdose Lambey
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Aim
The aim was to determine the epidemiology of invasive fungal infections at Chris
Hani Baragwanath Hospital. The specific objectives were to determine the 1) risk
factors, 2) clinical presentation, 3) laboratory abnormalities, 4) organisms and their
susceptibilities and 6) outcome in neonates with positive blood or CSF fungal
cultures at Chris Hani Baragwanath Hospital.
Methods
This was a retrospective record review of patients who had positive blood or CSF
cultures. Patients were identified by a computerized microbiological surveillance
database. The data was collected over a three-year period from January 2002 to
December 2004. Patient hospital files were reviewed for clinical signs, full blood
count (FBC), C-reactive protein (CRP) and outcomes. Fungal culture results were
reviewed for susceptibilities. To identify risk factors a convenient cohort was
compared to the patients with fungal sepsis. The data was analysed using a
Statistica software package.
Results
There were 150 patients with fungal sepsis among admissions over this 3 yearperiod
giving an incidence of 1.3 per 100 admissions. Thirty-nine records were not
found 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
6.3% had early onset fungal sepsis. There were 61 males. Twenty-eight percent of
patients were born to HIV positive mothers. Candida parapsilosis was the
commonest (56%) organism isolated followed by C. albicans (43%). All the C.
albicans isolates and 93% of the C. parapsilosis isolates were susceptible to
amphotericin B. Fluconazole susceptibilities were reported as, 96% for C.
albicans, and 60% of the C. parapsilosis as being susceptible. Central venous
catheters (CVCs) (p=<0.001), the use of TPN (p=<0.001) and third generation
cephalosporins were identified as risk factors associated with fungal sepsis. The
all-cause mortality and Candida–related mortality were 30% and 23%
respectively. The non-survivors had lower platelet counts (p=0.007) than the
survivors. Patients with Gram-negative sepsis had lower platelet counts than the
fungal group (p=<0.001) on the repeat laboratory parameters.
Conclusion
The incidence is 1.3 per 100 admissions. Risk factors associated with fungal
sepsis are very low birthweight and gestational age, the use of TPN, CVCs and
third generation cephalosporins. Candida parapsilosis is the common organism
causing fungal sepsis in neonates. Candida albicans was associated with a higher
mortality. Thrombocytopenia is not organism specific to fungal sepsis.