الفهرس 
CRITICALLY ILL PATIENTSOnly 14 pages are availabe for public view
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Abstract
Critically ill patients are immune suppressed, invasively monitored and exposed to aggressive medical interventions that put them at increased risk of infectious complications while residing in ICU.
Fungal pathogens were an increasing important cause of infection among patients in intensive care unit. Mold infections continue to occur predominantly in patients who were neutropenic, had received a transplant, or had been treated with corticosteroid or cytotoxic agents. Those most at risk were patients who had CVCs, were receiving parentral nutrition, were on broad spectrum antibiotics, required hemdialysis and had high Acute Physiology and Chronic Health Evaluation (APACHE)
The challenge for the future in the management of pediatric nosocomial infection includes improving ways to measure nosocomial infection rates in infants and children, investigating new and multiresistant pathogens, controlling antibiotic use, and developing strategies effective for different providers of pediatric care.
In our study, we screened for colonization by fungal strains in patients admitted to pediatric intensive care unit in Ain Shams university hospital & for determining the possible associated factors
This study was conducted on 56 critically ill pediatric patient admitted to PICU from march 2008 to September 2008, every patient was examined& sampled at first day of admission& after three days of admission. Six patients died before the third day of admission. Fifty patients were examined& sampled for the second time.
All patients were subjected to the following; recording their data, thorough clinical examination, assessment of pediatric risk of mortality (PRISM), recording other laboratory parameters as recorded in their inpatient file, collection of samples& follow up of them to record their fates (either clinical improvement& discharge or death).
Samples were taken from the oropharyngeal, axillary, and rectal areas. All specimens were then cultured on Sabouraud dextrose agar. The analysis of samples included a direct examination, culture, isolation and identification on KB006 HiCandida Identification Kit test and Detection of susceptibility of isolates to antifungal drugs.
The ages of our patients ranged from 1.5 m to 14y. Most of studied cases (46.4%) were below 1 year of age & 60.7% of the total number of patients studied were female& only 39.3% were male
Commonest causes of admission of our patients to PICU were; sepsis alone or with other system diseases {33 patients (59%)}, central nervous system diseases (31patients), chest diseases (30 patients), abdominal diseases (16 patients) and cardiovascular diseases(10 patients)
All of our patients at ICU received antibiotics. Antacids represented the second most frequent treatment among the studied group {32 patients (53.6%)}, followed by Inotropics {16 patients (26.8%)}, followed by blood transfusion {13 patients (21.4%)}, Then antivirals {10 patients (16.1%)}
Twenty seven patients (48%) received their medications through central venous line, 21patients (37.5%) were attached to mechanical ventilator and 18 patients (32.1%) had urinary catheter fixed to them. Laboratory data including CBC, liver function tests, kidney function tests, CRP markedly varied between the individuals of the studied patient.
The predicted death rate for all our patients was 22% that estimated according to PRISM scoring system. PRISM score is a system used to assess the severity of illness in a population of pediatric patients in a PICU. And it was found that 38 patients (67.9%) were predicted to die by 25%, 9 patients (16.1%) were predicted to die by 26-50%, 5 patients (8.9%) were predicted to die by 51-75%& 4 patients (7.1%) were predicted to die by >76%. Follow up of patients revealed that the actual mortality rate was (42.9%) 24 patients.