الفهرس 
Fungal infectionOnly 14 pages are availabe for public view
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Abstract
Fungal infections have been reported following hepatobiliary surgery associated with immunosuppressed individuals. A high rate of Candida and other fungal infections has been documented in patients post hepatobiliary surgery on corticosteroids or immunosuppression drugs. Candida and Aspergillus are the most frequent fungi responsible for IFI. The incidence of nosocomial infection by Candida species is forth most common cause of nosocomial blood stream infection in the general hospital population. Candida is one of the ten leading causes of bloodstream infections in developed countries.
Invasive fungal infection is associated with high Invasive fungal infection is associated with high morbidity and mortality following major hepatobiliary surgery. The incidence of invasive fungal infection without any prophylactic treatment ranges from5%to 42% Candida spp. is the leading causative agent of 60%–90% of fungal infections followed by Aspergillus spp. (5%–20%) and Cryptococcus (3%).Candida blood stream infection is a serious problem in surgical ICU. Patients who require prolonged hospital stay, central venous catheters, total parenteral nutrition, mechanical ventilation, and broad Spectrum antibiotic, corticosteroid therapy and candida colonization are a significant risk factor in most patients. This study was a Prospective cohort hospital based study which was conducted at National Liver Institute (NLI) during the period from the first of May 2014 to the end of 2015. Number of patients included in this study was 210 undergo hepatobiliary surgeries of both sex and any age during the period from the first of august 2014 to august of 2015. A pre-designed questionnaire was used which include data about personal history, medical history and suggested risk factors for fungal infections. All of them were examined thoroughly, their data were registered and sampled at two times, one at day of admission to be sure that they are free of fungal infection and the second was after hepatobiliary surgery, then sample identification; Conventional methods for yeast and yeast-like isolates (Corn meal agar description, Germ tube formation, Urease test, finally cultured on HiCrome™ Candida Differential Media) and Morphological methods for filamentous isolates identification (Slide culture technique and cultured on Candida Differential Media).The study revealed the following findings: The study included 210 patients admitted to surgery department from august 2014 to august 2015, their mean ages was 39.2± 22.7years ranging from 0.15 -73y. Most of the studied cases (79%) were above 18 year of age and also it was noted that 56.7% of the total number of patients studied was male and 43.3% was female, 83.1% of patients above age of 18 were educated, 53.6 % of patients above age of 18 were not working, 92.3% of patients above age of 18 were married and 62.9%of the all studied patients were from urban areas. Incidence rate of fungal infection among patients undergone major hepatobiliary surgeries in national liver institute is (45.2%). Nearly 98 % of positive cultures were of candida species only 2.1% non-candida (aspergillus) as 47.4% had c. glabrata infection, 41.1% had candida albican infection, 4.2% c.tropicalis, 3.1% mixed tropicalis and c.non albican, 2.1% mixed c.albican and c.non albican and 2.1% A.nigra figure (2). After multivariate regression analysis; Age (p value 0.001), Antibiotic use (p value 0.05), HBV and/ or HCV infection (p value 0.006), Central Venous Catheter (p value 0.043), urinary catheter (p value 0.05), and ICU hospitalization more than 48 hours (p value 0 .000008) were the main predictors of fungal infection.