Fungemia and resistance to antifungal agents in a children's hospital

Raftopoulou, A., M. Tjanoudaki, E. Petridou, A. Pangalis (Athens, GR)


Fungemia represents a serious patients management problem as approximately 10% of the nosocomial blood stream infections are caused by Candida spp. and results in substantial mortality especially for the immunocompromised patients. The aim of this study was to estimate the fungemia in our hospital, a large teaching pediatric hospital and to evaluate the susceptibility of the isolates to the antifungal agents in use today. From January 1998 till October 2000 39746 blood cultures were performed in the lab by the Bactec 9240 system and the use of PEDS PLUS/F bottles.The patients, 14 days till 16 year old, were from the general wards or were nursed in ICUs for fetal immaturity, haematological diseases (mainly leukemia), malignant tumors, large general surgery, bone marrow transplantation, renal insufficiency.All patiens had received antibiotics prior to blood fungus detection. The blood cultures revealed 35 positive for fungi samples id 0.1%, coming in majority from the ICUs (85.7%).The isolates were: Candida albicans 26 strains, C. parapsilosis 3, C. tropicalis 2, C.guillermondii 1, C.krusei 1, Acremonium strictum 1, Aspergillus niger 1.The susceptibility testing for the yeasts isolates by the MICs estimation, gave 28,6% resistance to Itraconazole, 7.1% to Fluconazole and Flucytosine and no resistance to Amphotericine and Ketoconazole. Despite the appropriate therapy 10 patients (28.5%) died during the period of fungal infection management.This mortality rate is very high.Probably the use of a more specific for fungi blood culture isolation method would result in fungal detection in an earlier infection stage which would benefit the patient in treatment and survival rate.

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11th European Congress of Clinical Microbiology and Infectious Diseases
    • ECCMID 11th (2001)