الفهرس 
Fever and NeutropeniaOnly 14 pages are availabe for public view
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Abstract
Pediatric patients with immunodeficiency and malignancy have an increased incidence of septicemia with a high case fatality rate (10 to 50%). Moreover, prolonged hospitalization, broad spectrum empirical antimicrobial therapy, and supportive care have a strong impact on the cost of care.
Rapid detection of the infectious cause and prompt initiation of appropriate antimicrobial treatment are fundamental for the successful treatment of septic patients and for the reduction of antibiotic resistance rate.
Therefore we use PCR in order to increase the speed of diagnosis by shortening the turnaround time combined with increase the sensitivity as by shortening the time to pathogen identification and allowing for detection of organisms missed by blood culture, molecular methods may contribute to the reduction of hospital stay as well as deceases in mortality.
This study was a cross-sectional observational study that carried out on 45 immunocompromised patients with sepsis in heamatology and oncology department of Ain shams university children hospital and compared their culture results to those of PCR. Patients were subjected to revising of records, sofa score and routine laboratory results.Microbiological analysis: Bacterial culture and antibacterial sensitivity test, fungal culture and antifungal sensitivity test.
PCR: blood samples were obtained and DNA was extracted from the samples using Qiagen DNA tissue kit for MRSA, Acinetobacter, Pseudomonas, E coli, Klebsiella, Candida species and Aspergillus.
10 different organisms detected by blood culture in 10 patients (22.2%) compared to 22 different organisms detected by PCR in 19 patients (42.2%) and this indicates a higher frequency of positive PCR results compared to conventional blood culture results. PCR had a very high sensitivity (100%), specificity (74.3%), PPV (52.6%), NPV (100%) and accuracy (80%). from blood culture and PCR, 22 pathogenic organisms were isolated during 45 sepsis episodes. Of these organisms, 10 were isolated during the same episode by both methods. All 10 organisms identified by blood culture were detected by PCR. PCR detected 12 organisms that were not identified using blood culture (1 acinetobacter, 2 candida albicans, 5 candida krusei, 1candida not typed, 2 E.coli and 1 MRSA).
Acinetobacter isolates in blood culture showed high rate of resistance (100%) to amoxicillin, amoxicillin\ clavulinic, pipercillin\tazobactam, meropenem, cephalexin, cefuroxime, cefotaxim, ceftazidime, fluoroqinolones, cefepime, amikin, tigecyclin, carbapenem, impipenem\cilastatin and showed sensitivity only to colistin (100%) and gentamycin (25%).Klebsiella isolates showed high rate of resistance (100%) to amoxicillin, amoxicillin\clavulinic, cephalexin, cefuroxime, cefotaxim, ceftazidime, ciprofloxacin, cefepime, amikin, impipenem\cilastatin and colistin,and showed sensitivity to tigecyclin and pipercillin\tazobactam, meropenem, levofloxacin, gentamycin and carbapenem while, E.coli isolate showed sensitivity to all antibiotics.
Candida albicans isolate showed resistance to itraconazole, posaconazole, fluconazole, caspofungin, micafungin and flurocytosin and showed sensitivity only to ketoconazole.
Aspergillus isolate showed resistance to fluconazole, caspofungin, micafungin and flurocytosin and showed sensitivity to ketoconazole, itraconazole and posaconazole.
6 patients died (13.3%) while 39 survived (86.7%). The median length of stay was 24 days. 35 (77.8%) patients were neutropenic.
There is statistically significant difference between number of deceased and survivors according to blood culture results and PCR results, as half of the deceased 3 patients out of 6 were blood culture positive (all of them were bacterial) and 5 out of 6 deceased (83.3%) showed positive PCR results.
Comparing community acquired infection and nosocomial infection shows no significant difference between them regarding mortality, length of hospital stay, blood culture positivity and PCR positivity.