الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Preterm infants are usually unable to ingest, absorb and digest oral nutrition for a prolonged period of time. Thus, parenteral nutrition (PN) should be commenced immediately within 6 hours of birth. Intravenous fat emulsion (IVFE) is one of the constituents of PN that supplies essential fatty acids required for the maturation of brain, retina and nerve cells. It is also a compact form of energy. However, the risk of microbial contamination of IVFE may lead to neonatal sepsis and mortality. Risk of contamination has been postulated by many studies to be related to extended hanging time of IVFE (24 hours rather than the recommended 12 hours). Another risk factor for contamination is the re-packaging of the IVFE bottles into syringes with smaller volumes.
The present cross sectional study was carried out on 152 IVFE samples over a period of 3 months from October to December 2017. The study was carried out at NICU, El Shatby University Hospital, and Alexandria.
The study aimed to:
1- Isolate and identify the microbial contaminants from fat emulsion.
2- Determine antimicrobial resistance pattern of the identified isolates.
3- Evaluate the risk factors associated with preparation of the fat emulsion
A volume of 10ml of IVFE was collected under complete aseptic techniques using a sterile syringe. 19 samples were collected immediately after opening the bottles of IVFE. Also, samples were collected from re-packaged syringes after 12 hours and 24 hours infusion time (73,79 samples respectively). Re-packaged syringes and their infusion lines were immediately transported to the laboratory in an icebox. Samples of IVFE were withdrawn from the line aseptically using another syringe, where they IVFE was aseptically introduced into brain heart infusion medium and incubated at 37°C. Blind subculture was done daily on blood and MacConkey’s agar plates at 37°C. Moreover, two plates of Sabouraud dextrose agar (SDA) supplemented with chloramphenicol were inoculated using a cotton swab. One of the SDA plates was overlaid with sterile olive oil and incubated at 35°C for 5 days for isolation of Malassesia furfur. The other plate was incubated aerobically at 28°Cfor 5 days.
Antimicrobial susceptibility testing for bacterial isolates was carried out by Kirby Bauer disc diffusion method following CLSI guidelines.
The result of this study revealed that:
1- Microbial growth was found in 15.8% samples. Positive samples were comprised of: K. pneumoniae (29.2%), C. albicans (20.8%), A. baumannii and S. aureus (12.5% each), (P. aeruginosa and CoNS: 8.3% each) and lastly, E. coli and E. faecalis (4.2% each).
2- Microbial contamination of repackaged syringes increased from 9.6% at 12 hours, to 21.5 % at 24 hours. This difference was found to be statistically significant (p value = 0.044)
3- The prevalence of gram negative isolates was 8.6%, gram positive isolates were 4.0 % and Candida isolates prevailed in 3.3% of IVFE cultures.
4- P. aeruginosa (n=2) and E. coli (n=1) appeared only in samples collected at 12 hours and not at 24 hours. On the other hand, A. baumannii (n=3),
E. faecalis (n=1) and S. aureus (n=3)appeared only in samples at 24 hours.
5- A similar trend of predominance of K. pneumoniae and C. albicans, in both IVFE and neonatal cultures, was observed.
6- Neonatal cultures showed higher prevalence of CoNS isolates (36%) compared to those isolated from IVFE samples (8.3%)
7- There was a statistically significant better performance of infection control measures of pharmacists rather than nurses.
8- The isolate of E. coli was MDR, with resistance to Gentamicin, Cefazoline and Cefoxitine. Two out of the three S. aureus isolates were identified MRSA based on Cefoxitine resistance. P. aeruginosa isolates (n =2) showed resistance pattern as follows: Gentamicin (50%), Ceftazidime (50%), A. baumannii isolates (n =3) showed 66.7% MDR resistance to the following antibiotics: Gentamicin, Piperacillin-tazobactam and Ceftazidime.It was also shown that K. pneumoniae isolates (n= 7) showed antibiotic resistance in the following pattern: Gentamicin (71.4%), Cefazoline (85.7%) and Cefoxitine (85.7%).
9- None of the bacterial isolates were resistant to Levofloxacin while a considerably high resistance (50% - 100%) was seen among most isolates to Gentamicin. Both antibiotics are among the antimicrobial protocol for this NICU department.
It can be concluded from this study that:
1- The rate of IVFE contamination was less at 12 hours than at 24 hours infusion time.
2- K. pneumoniae and C. albicans were the commonest pathogens isolated from IVFE and neonates
3- Compliance to infection control measures was significantly worse among nurses compared to pharmacists.
4- Bacterial isolates were MDR on antibiotic susceptibility testing.