Mona Mohiedden A.Haleim
Department of Clinical Pathology, Faculty of Medicine, Cairo University, Egypt
Title: Identification and differentiation of the most clinically involved candida species in neonates with candidemia admitted to NICU in Cairo-University Specialized Paediatric Hospital (CUSPH)
Biography
Biography: Mona Mohiedden A.Haleim
Abstract
Background: Candidemia studies have documented geographic differences in rates and epidemiology. Although Candida albicans continues to be the most common and virulent cause of Candida blood stream infection (BSI), longitudinal studies have detected an increase in the incidence of BSI caused by other Candida species that are known to be inherently less susceptible to commonly used antifungal drugs.
Study Question: Is to investigate the new trend of neonatal candidemia due to most commonly encountered Candida species using simple and reliable technique. Methods:: Blood cultures were performed in BACTEC instrument for 107 neonates admitted to Neonatal Intensive Care Unit -Cairo University Specialized Pediatric Hospital (CUSPH). All study population was suffering from prolonged hospitalization with fever of unknown origin, inadequate antibiotic response for at least one week. Detection of candidemia and species identification of isolates were performed according to its standard protocol. All blood culture bottles of the Candida isolates, and bottles that didn't flag positive and gives negative subculture on Sabaraud dextrose agar (SDA) and sheep blood agar (SBA) 5th day of incubation in BACTEC instrument were further identified and differentiated using PCR technique. The non-systematic collection and storage of samples were a limitation of our study.
Results: 98 (91.6%) out of 107 studied cases were culture positive for fungus. 90 of these cases (91.8%) were PCR positive, while 8 cases (8.16%) were not identified by PCR. The agreement between the two techniques was 0.229 (P-value 0.017). The designated inner primers for the given Candida species identified all 96 cases to species level were 70/107 (65.4%) as Candida albicans, 14/107 (13.1 %) as Candida tropicalis, 12/107 (11.2 %) as Candida glabrata. All cases that showed positive Germ tube test 45/98 (45.9%) were confirmed as Candida albicans by PCR. There was no statistically significant difference between identified Candida species in the present study regarding clinical diagnosis or demographic criteria.
Conclusions:Notably we have performed a reliable technique for comprehensive identification of clinically relevant Candida isolates, and ascertained significant data on many technical points including; specimen type, time and storage conditions. Performing a study for evaluation of the effect of different blood fractions on the reproducibility of PCR results for diagnosis of candidemia is recommended. Public Health Implications: PCR technique is more specific and rapid than conventional culture method. Moreover, the improved detection and discrimination between infecting Candida species is additional advantage information that is crucial for initiating specific antifungal therapy.
Key words: Candidemia - PCR- NICU - Candida species- blood stream infection
