الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Advances in the management of malignant diseases during the last few decades have
dramatically improved the prognosis of patients with malignancy and haematological
disorders.
With the increasing number of immune compromised patients, invasive fungal
infections have emerged as a major cause of morbidity and mortality among neutropenic
patients who have received courses of single or combined broad spectrum antibiotics.
Although the actual incidence of the IFIs has increased, its real frequency is often
underestimated because of the difficulty in diagnosis.
Delayed diagnosis and antifungal treatment contribute significantly to the high
mortality rates associated with invasive fungal infections, whereas early intervention with
antifungal drugs may result in more effective management of high-risk patients.
Knowledge of potential causative organisms is required to aid the diagnostic process,
mainly in situations where systemic fungal infection is suspected but the clinical
presentation is nonspecific.
Blood cultures are still considered to be the ‘goldstandard’ for the detection of
microbial pathogens related to bacteremia and sepsis despite newer molecular techniques.
Various commercial blood culture systems are available.
The various blood culture systems compete with regard to sensitivity for organism
recovery, workload capacity, user interface and associated costs.
It is very important to perform in vitro antifungalsusceptibility testing (AFST) which
should provide useful information for appropriate selection of the most active antifungal
therapy against different etiological agents, as we ll as to predict treatment outcome or explain
some resistance cases
The aim of the current work was to study the efficiency of automated blood culture
system Bactec 9050 in the diagnosis of invasive fungal infection in neutropenic cancer
patients versus conventional biphasic blood culturebottles and to study the Antifungal
susceptibility testing of the isolates.
It included 100 neutropenic cancer patients admitted to the Hematology Department
and to the Clinical Oncology and Nuclear Medicine Department in the Medical Research
Institute Hospital in Alexandria and Gamal Abdel Naser Insurance Hospital in Alexandria.
The 100 neutropenic cancer patients in the current study, included 65 cases (65%) males and
35 (35%) females the age of the study group ranged from 6 to 76 the mean of age 37 and the
standard deviation of the age is 18.66.
Out of the 100 neutropenic cancer patients included in the current study 67 patients
(67%) had hematological malignancies out of them 52 patients (52%) had leukemia , 9
cases (9%) had lymphoma and 6 patients (6%) had multiple myeloma , 15 cases (15%) had
cancer breast, 5 cases (5%) had cancer colon, 5 cases (5%) had cancer prostate, 7 cases
(7%) had cancer liver and 1 case (1%) had cancer head of pancreas.
All the 100 neutropenic cancer patients (100%) included in the current study had
fever, 35 patients (35%) had oral thrush, 21 patients (21%) had cough, 15 cases (15%) had
dysuria and 12 cases (12%) had symptoms of vaginitis, all the patients enrolled in the
current study had fever more than 38 °C for a duration less than 10 days, with range from
2-9 days and mean 5.5 days.
The risk factors detected among the 100neutropnic cancer patients were;
hospitalization in 100 cases (100%) followed by IV drips in 95 cases (95%), antibiotic
therapy in 93 cases (93%), 60 cases (60%) were under chemotherapy meanwhile 28 cases
(28%) were receiving steroids therapy and 22 cases (22%) had radiotherapy. These results
were found to be statistically non-significant (P value was > 0.05).
17 cases (17%) had neutropenia less than 500 cells/ mm
3
for 10 days or more,
whereas 83 cases (83%) had neutropenia more than 500 cells / mm
3
for less 10 days.
The 100 neutropenic cancer patients included in thecurrent study were tested for
fungal blood culture by conventional and bactec 9050 blood culture systems.
Out of the study group 20 cases (20%) were positiveby bactec 9050 blood culture
system. Meanwhile, only 5 patients (5 %) were positive for fungal infection by
conventional blood.
Out of the 20 cases (20%) positive for fungal infection, 17 cases (17%) had Candida
species and 3 cases (3%) had Asperigillus species detected by bactec 9050 blood culture
system.
Among the 20 positive cases for fungal blood culture all the 20 positive cases
(100%) were feverish, 6 positive cases (30%) had oral thrush, 6 positive cases (30%) had
cough, 3 positive cases (15%) had dysuria and 2 positive cases (10%), had symptoms of
vaginitis.
In our study, out of the 85 patients who received anti-fungal agents as a prophylaxis
18 cases (90%) were positive by blood culture system for fungaemia among the 20 positive
cases whereas between the 15 patients who did not take the antifungal agents as a
prophylaxis only 2 cases (10%) among the 20 positive cases were positive for fungaemia
by blood culture system. 13 cases (65%) of positivefor fungaemia by blood culture
systems had neutropenia less than 500 cells/mm
3
whereas 7 cases (35%) of positive
fungaemia by blood culture systems had neutropenia more than 500 cells/mm
3
.
The Fungifast kit was used in the current study foranti-fungal susceptibility testing
of the isolated candida spp. against Amphotericin B, fluconazole, voriconazole, flucytosine
and itraconazole.
The kit is incubated at 37°C for 24-48 h and read manually for colorimetric changes
as performance studies showed better results after 48 hours incubation.
Out of the of the 17 Candida sp isolated from the 100 neutropenic cancer patients
included in the current study, 15 cases (88.23%) were sensitive for amphotericin B, 13
cases (76.47%) were sensitive for fluconazole, 13 cases (76.47%) were sensitive for
voriconazole, 10 cases (58.2%) were sensitive for 5flucytosine and finally 12 cases
(70.5%) were sensitive for itraconazole.
In conclusion, BACTEC 9050 has been proven as are reliable and fast method to
identify the blood stream pathogens in blood cultures. The optimal choice of blood culture
media will clearly need to evolve with future advances in blood culture technology and an
understanding of their impact on clinical outcome.