RESUMO
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
RESUMO
Purpose: to evaluate the bacterial contamination associated with contact lenses and lens care solutions used by a group of soft contact lens [CL] users [daily and extended wear CL] and the susceptibility pattern of the isolated organisms to antibiotics for 12 months duration
Methods: this prospective case controlled, non-randomized study included 50 participants of contact lens [CL] wearers from Outpatient Clinics at Al-Azhar University Hospitals, International Eye Hospital New Damietta and available special clinics, [between 2013 and 2014]. The sample population was divided into two groups: a Case group: 30 contact lens users [60 eyes] were suffering from symptoms and signs of conjunctivitis in one or both eyes; a Control group: 20 CL users were not suffering from conjunctivitis. Samples were taken from solution in contact lens storage cases; daily wear CL, extended wear CL, and conjunctiva were cultured on different media. Microbiological identification of the organisms and their antimicrobial susceptibility were done in accordance to standard protocols
Results: in the case group, positive growth was found in 85% of the lens care solution, 65% of the contact lenses, and 56.7% of the conjunctiva of participants. While in the control group, it was found in 10% , 20% and 15% respectively, with a statistically significant difference between both groups [P<0.001]. There was no statistically significant differences between the two usage schedules [daily wear and extended wear] regarding results of solution and contact lens cultures [p =0.599] and [p=0.694] respectively, but there was a significant higher growth in the conjunctival cultures of extended wear contact lenses [p =0.014]. The isolated organisms in case group were; Staphylococcus epidermidis [36.3%], followed by Pseudomonas aeruginosa [34.7%], Staphylococcus aureus [15.3%], Anthracoid [5.6%], Escherichia coli [4.1%], Diphtheroid [1.6%], Non haemolytic streptreptococci [1.6 %] and least was found to be Mycoplasma [0.8%]. Antibiotic susceptibility tests revealed that all isolates are sensitive to gatifloxacin, Impenem and ciprofloxacin which are commercially ophthalmological antibiotics
Conclusion: prevention of bacterial contamination of contact lens can reduce the risk of developing ocular infections. Lens care practices amongst the participants were not optimum which resulted into high contamination level. Hence, creating awareness among the users about the lens care practices and regular cleaning and replacements of lens cases are required