Objectives: 1- To identify Candida species isolated from nosocomial infection cases and to determine their antifungal susceptibility patterns. 2- To describe the epidemiological features of nosocomial Candida infections (NCI) and the risk factors associated with such infections in our hospital. Methods: A total of 16095 patients hospitalized in Assuit University Hospital, during the period from October 2009 to May 2011. They were monitored for development of nosocomial infections. Clinical specimens were screened for isolation of Candida species. Candida isolates were identified by conventional phenotypic methods and seminested PCR (snPCR). Antifungal susceptibility testing to fluconazole, amphotericin B, ketoconazole, itraconazole, nystatin, and voriconazole was determined by the disc diffusion method or the E-test. Risk factors and mortality rate were determined in association with Candida infections. Results: Three hundreds and twelve (1.94%) patients had acquired nosocomial infections. One hundred and twenty seven Candida strains were isolated from various clinical specimens (blood, urine, endotracheal aspirate, sputum, oropharyngeal swabs, wounds, and bed sores) collected from 119 (38%) nosocomially infected patients. The nosocomial infection rate due to Candida spp. was 0.74% and it was significantly higher in ICUs (92.4%) than in other wards. Candida spp. (16%) were the third common organisms isolated from nosocomially infected patients after Klebsiella spp. (29.5%) and MRSA (24%). NCI occurred most frequently among patients admitted at the chest ICU (46%) and at the trauma ICU (25%). Non-albicans Candida spp. isolates were frequently isolated (75%) in comparison to C. albicans (25%). Frequent isolates were from urine (43.3%). All Candida isolates were sensitive to amphotericin B and voriconazole, while resistance to fluconazole, ketoconazole, itraconazole, and nystatin was 6%, 13%, 32 %, and 1 % respectively. Binary logistic regression analysis of risk factors identified that older age (≥60 years) (Odds ratio (OR), 1.01; 95% Confidence interval (CI), 1.01-1.02, P value= 0.02) and surgical procedures (OR, 0.4; 95% CI, 0.2-0.2, P value= 0.01) were independently associated with NCI. The overall mortality rate among patients with NCI was 28%. Conclusion: Candida species are important nosocomial pathogens in the ICUs especially non-albicans Candida spp. which are frequent. The resistance to antifungal therapeutic agents is still low.

Invasive fungal infection is a leading cause of infection related mortality among patients with hematological malignancies, associated with prolonged and severe neutropenia. So, antifungal prophylaxis may be a good approach for neutropenic patients undergoing intensive myelosuppresive chemotherapy. Aim of the study: to study the prevalence and types of Candida colonization among neutropenic pediatric patients with hematological malignancies, to study the role of antifungal prophylaxis in decreasing Candida colonization and infection and in prevention of invasive Candida infection among severe and prolonged neutropenic children with hematological malignancies. Methods: the study included 64 children patients with severe and prolonged neutropenia associated with hematological malignancies. Group I: 32 patients received Fluconazole prophylaxis and Group II: 32 patients received placebo. Candida colonization and types was identified using phenotypic methods (Sabouraud's Dextrose agar, Hichrome Candida Differential agar, Cezpek Dox Agar with Tween 80, Germ tube test and Sugar assimilation test) and genotypic methods using PCR to detect type and species of Candida; for different samples [oral, rectal, blood, and urine] at base line and end of the study. Antifungal susceptibility test using agar disc diffusion method was used to test isolated strains. IgM for Candida albicans was done for all patients. Results: Pediatric patients (N = 64) with age 1.5 – 16 years old, 45 males and 19 females, with hematological malignancies and severe prolonged neutropenia. Colonization by Candida species was found in 54 samples (42%) in group I at base line against 47 samples (37%) in group II (P = 0.08), most of them from oral and rectal samples. These isolates were C. albicans (33), C. glabrata (6), and C. tropicalis (3) in group I, against 31, 7, and 2 isolates respectively in group II at base line (P= 0.295). For all types of samples; C. albicans was the most sensitive isolate to fluconazole followed by C.glabrata and C. tropicalis. There was reduction of overall colonization in group I from 42% to 38% while increase in colonization from 37% to 56% in group II (P = 0.08). IgM for C. albicans was statistically significant (P= 0.02) with the subgroups of hematological malignancies.Conclusion:Candida species colonization is a common problem in children with hematological malignancies and severe neutropenia. C. albicans is the most common species encountered in isolated samples. It's also the most sensitive to fluconazole. Fluconazole plays a major role in reduction of colonization, so it's recommended to use it in such cases.

Invasive fungal infection is a leading cause of infection related mortality among patients with hematological malignancies, associated with prolonged and severe neutropenia. So, antifungal prophylaxis may be a good approach for neutropenic patients undergoing intensive myelosuppresive chemotherapy. Aim of the study: to study the prevalence and types of Candida colonization among neutropenic pediatric patients with hematological malignancies, to study the role of antifungal prophylaxis in decreasing Candida colonization and infection and in prevention of invasive Candida infection among severe and prolonged neutropenic children with hematological malignancies. Methods: the study included 64 children patients with severe and prolonged neutropenia associated with hematological malignancies. Group I: 32 patients received Fluconazole prophylaxis and Group II: 32 patients received placebo. Candida colonization and types was identified using phenotypic methods (Sabouraud's Dextrose agar, Hichrome Candida Differential agar, Cezpek Dox Agar with Tween 80, Germ tube test and Sugar assimilation test) and genotypic methods using PCR to detect type and species of Candida; for different samples [oral, rectal, blood, and urine] at base line and end of the study. Antifungal susceptibility test using agar disc diffusion method was used to test isolated strains. IgM for Candida albicans was done for all patients. Results: Pediatric patients (N = 64) with age 1.5 – 16 years old, 45 males and 19 females, with hematological malignancies and severe prolonged neutropenia. Colonization by Candida species was found in 54 samples (42%) in group I at base line against 47 samples (37%) in group II (P = 0.08), most of them from oral and rectal samples. These isolates were C. albicans (33), C. glabrata (6), and C. tropicalis (3) in group I, against 31, 7, and 2 isolates respectively in group II at base line (P= 0.295). For all types of samples; C. albicans was the most sensitive isolate to fluconazole followed by C.glabrata and C. tropicalis. There was reduction of overall colonization in group I from 42% to 38% while increase in colonization from 37% to 56% in group II (P = 0.08). IgM for C. albicans was statistically significant (P= 0.02) with the subgroups of hematological malignancies.Conclusion:Candida species colonization is a common problem in children with hematological malignancies and severe neutropenia. C. albicans is the most common species encountered in isolated samples. It's also the most sensitive to fluconazole. Fluconazole plays a major role in reduction of colonization, so it's recommended to use it in such cases.

Invasive fungal infection is a leading cause of infection related mortality among patients with hematological malignancies, associated with prolonged and severe neutropenia. So, antifungal prophylaxis may be a good approach for neutropenic patients undergoing intensive myelosuppresive chemotherapy. Aim of the study: to study the prevalence and types of Candida colonization among neutropenic pediatric patients with hematological malignancies, to study the role of antifungal prophylaxis in decreasing Candida colonization and infection and in prevention of invasive Candida infection among severe and prolonged neutropenic children with hematological malignancies. Methods: the study included 64 children patients with severe and prolonged neutropenia associated with hematological malignancies. Group I: 32 patients received Fluconazole prophylaxis and Group II: 32 patients received placebo. Candida colonization and types was identified using phenotypic methods (Sabouraud's Dextrose agar, Hichrome Candida Differential agar, Cezpek Dox Agar with Tween 80, Germ tube test and Sugar assimilation test) and genotypic methods using PCR to detect type and species of Candida; for different samples [oral, rectal, blood, and urine] at base line and end of the study. Antifungal susceptibility test using agar disc diffusion method was used to test isolated strains. IgM for Candida albicans was done for all patients. Results: Pediatric patients (N = 64) with age 1.5 – 16 years old, 45 males and 19 females, with hematological malignancies and severe prolonged neutropenia. Colonization by Candida species was found in 54 samples (42%) in group I at base line against 47 samples (37%) in group II (P = 0.08), most of them from oral and rectal samples. These isolates were C. albicans (33), C. glabrata (6), and C. tropicalis (3) in group I, against 31, 7, and 2 isolates respectively in group II at base line (P= 0.295). For all types of samples; C. albicans was the most sensitive isolate to fluconazole followed by C.glabrata and C. tropicalis. There was reduction of overall colonization in group I from 42% to 38% while increase in colonization from 37% to 56% in group II (P = 0.08). IgM for C. albicans was statistically significant (P= 0.02) with the subgroups of hematological malignancies.Conclusion:Candida species colonization is a common problem in children with hematological malignancies and severe neutropenia. C. albicans is the most common species encountered in isolated samples. It's also the most sensitive to fluconazole. Fluconazole plays a major role in reduction of colonization, so it's recommended to use it in such cases.

Invasive fungal infection is a leading cause of infection related mortality among patients with hematological malignancies, associated with prolonged and severe neutropenia. So, antifungal prophylaxis may be a good approach for neutropenic patients undergoing intensive myelosuppresive chemotherapy. Aim of the study: to study the prevalence and types of Candida colonization among neutropenic pediatric patients with hematological malignancies, to study the role of antifungal prophylaxis in decreasing Candida colonization and infection and in prevention of invasive Candida infection among severe and prolonged neutropenic children with hematological malignancies. Methods: the study included 64 children patients with severe and prolonged neutropenia associated with hematological malignancies. Group I: 32 patients received Fluconazole prophylaxis and Group II: 32 patients received placebo. Candida colonization and types was identified using phenotypic methods (Sabouraud's Dextrose agar, Hichrome Candida Differential agar, Cezpek Dox Agar with Tween 80, Germ tube test and Sugar assimilation test) and genotypic methods using PCR to detect type and species of Candida; for different samples [oral, rectal, blood, and urine] at base line and end of the study. Antifungal susceptibility test using agar disc diffusion method was used to test isolated strains. IgM for Candida albicans was done for all patients. Results: Pediatric patients (N = 64) with age 1.5 – 16 years old, 45 males and 19 females, with hematological malignancies and severe prolonged neutropenia. Colonization by Candida species was found in 54 samples (42%) in group I at base line against 47 samples (37%) in group II (P = 0.08), most of them from oral and rectal samples. These isolates were C. albicans (33), C. glabrata (6), and C. tropicalis (3) in group I, against 31, 7, and 2 isolates respectively in group II at base line (P= 0.295). For all types of samples; C. albicans was the most sensitive isolate to fluconazole followed by C.glabrata and C. tropicalis. There was reduction of overall colonization in group I from 42% to 38% while increase in colonization from 37% to 56% in group II (P = 0.08). IgM for C. albicans was statistically significant (P= 0.02) with the subgroups of hematological malignancies.Conclusion:Candida species colonization is a common problem in children with hematological malignancies and severe neutropenia. C. albicans is the most common species encountered in isolated samples. It's also the most sensitive to fluconazole. Fluconazole plays a major role in reduction of colonization, so it's recommended to use it in such cases.

Invasive fungal infection is a leading cause of infection related mortality among patients with hematological malignancies, associated with prolonged and severe neutropenia. So, antifungal prophylaxis may be a good approach for neutropenic patients undergoing intensive myelosuppresive chemotherapy. Aim of the study: to study the prevalence and types of Candida colonization among neutropenic pediatric patients with hematological malignancies, to study the role of antifungal prophylaxis in decreasing Candida colonization and infection and in prevention of invasive Candida infection among severe and prolonged neutropenic children with hematological malignancies. Methods: the study included 64 children patients with severe and prolonged neutropenia associated with hematological malignancies. Group I: 32 patients received Fluconazole prophylaxis and Group II: 32 patients received placebo. Candida colonization and types was identified using phenotypic methods (Sabouraud's Dextrose agar, Hichrome Candida Differential agar, Cezpek Dox Agar with Tween 80, Germ tube test and Sugar assimilation test) and genotypic methods using PCR to detect type and species of Candida; for different samples [oral, rectal, blood, and urine] at base line and end of the study. Antifungal susceptibility test using agar disc diffusion method was used to test isolated strains. IgM for Candida albicans was done for all patients. Results: Pediatric patients (N = 64) with age 1.5 – 16 years old, 45 males and 19 females, with hematological malignancies and severe prolonged neutropenia. Colonization by Candida species was found in 54 samples (42%) in group I at base line against 47 samples (37%) in group II (P = 0.08), most of them from oral and rectal samples. These isolates were C. albicans (33), C. glabrata (6), and C. tropicalis (3) in group I, against 31, 7, and 2 isolates respectively in group II at base line (P= 0.295). For all types of samples; C. albicans was the most sensitive isolate to fluconazole followed by C.glabrata and C. tropicalis. There was reduction of overall colonization in group I from 42% to 38% while increase in colonization from 37% to 56% in group II (P = 0.08). IgM for C. albicans was statistically significant (P= 0.02) with the subgroups of hematological malignancies.Conclusion:Candida species colonization is a common problem in children with hematological malignancies and severe neutropenia. C. albicans is the most common species encountered in isolated samples. It's also the most sensitive to fluconazole. Fluconazole plays a major role in reduction of colonization, so it's recommended to use it in such cases.

Objectives: 1- To identify Candida species isolated from nosocomial infection cases and to determine their antifungal susceptibility patterns. 2- To describe the epidemiological features of nosocomial Candida infections (NCI) and the risk factors associated with such infections in our hospital. Methods: A total of 16095 patients hospitalized in Assuit University Hospital, during the period from October 2009 to May 2011. They were monitored for development of nosocomial infections. Clinical specimens were screened for isolation of Candida species. Candida isolates were identified by conventional phenotypic methods and seminested PCR (snPCR). Antifungal susceptibility testing to fluconazole, amphotericin B, ketoconazole, itraconazole, nystatin, and voriconazole was determined by the disc diffusion method or the E-test. Risk factors and mortality rate were determined in association with Candida infections. Results: Three hundreds and twelve (1.94%) patients had acquired nosocomial infections. One hundred and twenty seven Candida strains were isolated from various clinical specimens (blood, urine, endotracheal aspirate, sputum, oropharyngeal swabs, wounds, and bed sores) collected from 119 (38%) nosocomially infected patients. The nosocomial infection rate due to Candida spp. was 0.74% and it was significantly higher in ICUs (92.4%) than in other wards. Candida spp. (16%) were the third common organisms isolated from nosocomially infected patients after Klebsiella spp. (29.5%) and MRSA (24%). NCI occurred most frequently among patients admitted at the chest ICU (46%) and at the trauma ICU (25%). Non-albicans Candida spp. isolates were frequently isolated (75%) in comparison to C. albicans (25%). Frequent isolates were from urine (43.3%). All Candida isolates were sensitive to amphotericin B and voriconazole, while resistance to fluconazole, ketoconazole, itraconazole, and nystatin was 6%, 13%, 32 %, and 1 % respectively. Binary logistic regression analysis of risk factors identified that older age (≥60 years) (Odds ratio (OR), 1.01; 95% Confidence interval (CI), 1.01-1.02, P value= 0.02) and surgical procedures (OR, 0.4; 95% CI, 0.2-0.2, P value= 0.01) were independently associated with NCI. The overall mortality rate among patients with NCI was 28%. Conclusion: Candida species are important nosocomial pathogens in the ICUs especially non-albicans Candida spp. which are frequent. The resistance to antifungal therapeutic agents is still low.

Objectives: 1- To identify Candida species isolated from nosocomial infection cases and to determine their antifungal susceptibility patterns. 2- To describe the epidemiological features of nosocomial Candida infections (NCI) and the risk factors associated with such infections in our hospital. Methods: A total of 16095 patients hospitalized in Assuit University Hospital, during the period from October 2009 to May 2011. They were monitored for development of nosocomial infections. Clinical specimens were screened for isolation of Candida species. Candida isolates were identified by conventional phenotypic methods and seminested PCR (snPCR). Antifungal susceptibility testing to fluconazole, amphotericin B, ketoconazole, itraconazole, nystatin, and voriconazole was determined by the disc diffusion method or the E-test. Risk factors and mortality rate were determined in association with Candida infections. Results: Three hundreds and twelve (1.94%) patients had acquired nosocomial infections. One hundred and twenty seven Candida strains were isolated from various clinical specimens (blood, urine, endotracheal aspirate, sputum, oropharyngeal swabs, wounds, and bed sores) collected from 119 (38%) nosocomially infected patients. The nosocomial infection rate due to Candida spp. was 0.74% and it was significantly higher in ICUs (92.4%) than in other wards. Candida spp. (16%) were the third common organisms isolated from nosocomially infected patients after Klebsiella spp. (29.5%) and MRSA (24%). NCI occurred most frequently among patients admitted at the chest ICU (46%) and at the trauma ICU (25%). Non-albicans Candida spp. isolates were frequently isolated (75%) in comparison to C. albicans (25%). Frequent isolates were from urine (43.3%). All Candida isolates were sensitive to amphotericin B and voriconazole, while resistance to fluconazole, ketoconazole, itraconazole, and nystatin was 6%, 13%, 32 %, and 1 % respectively. Binary logistic regression analysis of risk factors identified that older age (≥60 years) (Odds ratio (OR), 1.01; 95% Confidence interval (CI), 1.01-1.02, P value= 0.02) and surgical procedures (OR, 0.4; 95% CI, 0.2-0.2, P value= 0.01) were independently associated with NCI. The overall mortality rate among patients with NCI was 28%. Conclusion: Candida species are important nosocomial pathogens in the ICUs especially non-albicans Candida spp. which are frequent. The resistance to antifungal therapeutic agents is still low.

Objectives: 1- To identify Candida species isolated from nosocomial infection cases and to determine their antifungal susceptibility patterns. 2- To describe the epidemiological features of nosocomial Candida infections (NCI) and the risk factors associated with such infections in our hospital. Methods: A total of 16095 patients hospitalized in Assuit University Hospital, during the period from October 2009 to May 2011. They were monitored for development of nosocomial infections. Clinical specimens were screened for isolation of Candida species. Candida isolates were identified by conventional phenotypic methods and seminested PCR (snPCR). Antifungal susceptibility testing to fluconazole, amphotericin B, ketoconazole, itraconazole, nystatin, and voriconazole was determined by the disc diffusion method or the E-test. Risk factors and mortality rate were determined in association with Candida infections. Results: Three hundreds and twelve (1.94%) patients had acquired nosocomial infections. One hundred and twenty seven Candida strains were isolated from various clinical specimens (blood, urine, endotracheal aspirate, sputum, oropharyngeal swabs, wounds, and bed sores) collected from 119 (38%) nosocomially infected patients. The nosocomial infection rate due to Candida spp. was 0.74% and it was significantly higher in ICUs (92.4%) than in other wards. Candida spp. (16%) were the third common organisms isolated from nosocomially infected patients after Klebsiella spp. (29.5%) and MRSA (24%). NCI occurred most frequently among patients admitted at the chest ICU (46%) and at the trauma ICU (25%). Non-albicans Candida spp. isolates were frequently isolated (75%) in comparison to C. albicans (25%). Frequent isolates were from urine (43.3%). All Candida isolates were sensitive to amphotericin B and voriconazole, while resistance to fluconazole, ketoconazole, itraconazole, and nystatin was 6%, 13%, 32 %, and 1 % respectively. Binary logistic regression analysis of risk factors identified that older age (≥60 years) (Odds ratio (OR), 1.01; 95% Confidence interval (CI), 1.01-1.02, P value= 0.02) and surgical procedures (OR, 0.4; 95% CI, 0.2-0.2, P value= 0.01) were independently associated with NCI. The overall mortality rate among patients with NCI was 28%. Conclusion: Candida species are important nosocomial pathogens in the ICUs especially non-albicans Candida spp. which are frequent. The resistance to antifungal therapeutic agents is still low.