Fungemia in Immunocompromised Patients (Hematological Malignant and Hematopoietic Stem Cell Transplant Patients during Febrile Neutropenia)

Hatem Mohamed Newishy1, Mohammed Mohammed Sherif1, Mohammed Mostafa Elsaadawy1,; Mostafa Mahmoud Elnakib3, Mohamed Hamed Khalaf 2,

Fungemia in Immunocompromised Patients (Hematological Malignant and Hematopoietic Stem Cell Transplant Patients during Febrile Neutropenia)

Document Type : Original Article

Authors

¹ 1 Microbiology and immunology Department, Faculty of Medicine, Al- Azhar University, Cairo, Egypt,

² 2 Oncology and Hematology Hospital, Maadi Armed Forces Medical Compound, Cairo, Egypt, 3 Microbiology and Immunology Department, Military medical academy, Cairo, Egypt

Abstract

Background: Fungal infections are a major cause of morbidity and mortality among febrile neutropenic patients.
The choice of empiric antifungal regimen is based on susceptibility pattern of locally prevalent pathogens.
Objectives: to determine fungemia, identify fungal spectrum and their antifungal susceptibility pattern.
Methods: From 150 hematological malignant and hematopoietic stem cell transplant patients during febrile neutropenia, blood cultures (B.C) were processed. Results: Eight fungal isolates (5.3%) were recovered which found to be represented by candida spp. Five of them were non albicans Candida (62.5%) and three of them were Candida albicans (37.5%). C. parapsilosis resulted in the most frequent Candida non albicans (CnA) species (37.5%). All C. parapsilosis strains were isolated from patients with vascular catheters. C. krusei fungemia generally occur in patients with previous exposure to fluconazoles. All species of Candida were sensitive to amphoterecin B, echinocandins and voriconazole. Persistent fever for prolonged duration and prolonged broad spectrum antibiotic use were statistically significant risk factors for developing fungemia. Also extent of neutropenia, duration of chemotherapy, immunosuppressive therapy, altered mucosal barriers and presence of central venous lines were considered major risk factors for development of fungemia. Conclusion: The current study was limited by method of diagnosis and low sample size in a single center experience. Furthermore review of the epidemiology of fungemia which was represented by candidemia at our institution revealed the percentage of candidemia was 5.3% and non albicans Candida species were the predominant isolates. Recommendations: The choice of therapy in neutropenic patients should be formulated based on local antimicrobial susceptibility of these organisms. Close monitoring of fungal infection in patients receiving broad-spectrum antibiotics is mandatory.

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