A research report submitted to the Faculty of Health Sciences, University of the
Witwatersrand, Johannesburg in partial fulfillment of the requirements for the degree of
Master of Medicine in the branch of Paediatrics and Child Health
29 May 2017 / Introduction
Sepsis, and in particular, severe sepsis, remains a major cause of death in children
worldwide. One of the areas where the burden of sepsis is keenly felt is in the paediatric
intensive care unit (PICU) setting, contributing significantly to childhood mortality.
Fungal organisms have emerged as a major organism contributing to nosocomial sepsis in
PICU. No local data regarding nosocomial fungal sepsis in the non-neonatal, PICU
population exists regarding this matter. This study describes the characteristics of patients
with nosocomial fungal sepsis in the PICU at South Africa’s largest hospital Chris Hani
Baragwanath Academic Hospital (CHBAH).
Methods
This study was a retrospective review of patient records. All patients aged 0-16 years
admitted to the PICU at Chris Hani Baragwanath Academic Hospital (CHBAH) from
January 2008 through December 2011 were assessed. A total of seventeen patients who
developed nosocomial fungal sepsis were included in this study.
Results
The incidence of candidaemia was reported to be 3.2 per 100 cases. The major age group
affected by nosocomial fungal sepsis was the under one age group. The most common
diagnoses on admission were lower respiratory tract infection (LRTI) followed by
haematology-oncology and acute gastroenteritis cases. ICU
factors
found
to
commonly
co-‐exist
with
proven
nosocomial
fungal
sepsis
were
presence
of
a
central venous
catheter (100%), mechanical ventilation (82%), arterial line (70%), and systemic
corticosteroid use (47%). The penicillin class was the most common antimicrobial that
patients were found to be on at the time of nosocomial sepsis. The most common fungal
organism as a cause for nosocomial sepsis was C. parapsilosis rather than C. albicans.
Furthermore, the majority of this study’s isolates were susceptible to voriconazole rather
the current empiric antifungal of choice, namely fluconazole.
Conclusion
The presence of central venous catheters, arterial lines, mechanical ventilation and
systemic corticosteroid use is common in paediatric patients with nosocomial fungal
sepsis. However, this study was unable to determine statistically significant factors
associated with fungal sepsis in a tertiary PICU due to the surprisingly small number of
cases (n=35) detected over a four-year period. This perhaps represents the most striking
finding of the study together with a concerning pattern of fluconazole resistance (14%)
among isolated organisms. / MT2017
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:wits/oai:wiredspace.wits.ac.za:10539/23349 |
| Date | January 2017 |
| Creators | Ahn, Seung-Hye |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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