الفهرس 
Acknowledgements
Fungal infection in immunocompromised patientsOnly 14 pages are availabe for public view
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Abstract
This hospital based descriptive study was conducted over a period of 1 year from may 2019 to May 2020 to include 100 patients who were admitted to different intensive care units (ICUs) at Assiut University Hospitals. The aim of this study is to diagnose invasive fungal infection in ICUs patients, identify the most common fungal species in immunocompromised patients and their antifungal sensitivity pattern. The patients selected under the study were patients admitted to intensive care units (ICU), and receiving different immunosuppressant treatments or acute hematological malignancy with intensive chemotherapy, cancer, diabetes mellitus (DM),transplant recipients as bone marrow and solid organ transplantation and patients on long term steroids, antibiotic therapy. Out of 100 from patients included in the current study with clinical suspicion of having fungal infections,there were (67%) males and (33%) females in the clinically diagnosed cases .with the mean ofage was 46.10±20.48 years with range of the age between1and 84years.most of patient (41%) were admitted to critical ICU. The most common risk factor was antibiotic therapy, presented in (75%) patients,followed by diabetes mellitus presented in (25%), on steroid therapy (18%),mechanical ventilation (13%),haematological malignancies (13%) and non-haematological malignancies (10%).Pneumonia was the most common diagnosis among enrolled patients followed by ureamic encephalopathy, presented in (41%) and (18%) patients, respectively. patients were admitted secondary to acute exacerbation of COPD(13%),patients with urinary tract infection (11%),patients with neutropenic fever(9%) and patients with septic shock(8%).Among the 100 fungal isolates, majority of them were yeast (90%), mold (10%) were.Microscopic examination of isolated fungi revealed budding yeast in 90 (90%) samples. Asp.penicillium, Asp.niger, and Asp.flavus were isolated in (2%), (4%) and (4%) samples, respectively. Among the 90 yeast isolates, majority of them were C.albicans and C.tropicals presented in (38.9%) and (37.8%) patients, respectively. Also, C.glabrata(8.9%) and C.krusei (11.1%) patients. C.tropicals were the most common fungi among all risk factors except neutropenic fever was C.albicans( 61.5%)Most common fungi in patients with pneumonia was C/albicans and C.tropicals with both (36.6%) ,followed by C.krusei(12.2%),C.glabrata(9.8%) and Asp.niger (4.9%)Determinationofin vitroantifungalsusceptibilitypatternfor yeastand mold strainsshowedthatAmphotericineB (95%)followedbymicafungin (94%) were the most sensitive drugs . Antifungal resistance in yeast was mainly related to fluconazole (35%) followed by flucytosine (29%). And (100%)for fluconazole and (50%) for flucytosine in mould isolates with higer rate of resistancce than yeast. Fluconazole resistance was observed among C.glabrata with (62.5%) , C.krusei with(30%) and C.tropicalis, C.albicans with (23.5%), (17.1%)respectively. Invasive fungal infections are a major cause of morbidity and mortality in immunocompromised patients. Theclinicalmanifestationsoffungalinfectionarenotspecific, colonization is difficult to distinguish from invasive disease ,blood cultures are commonly negative, patients are often unable to undergo invasive diagnostic proceduresandlikeotherinfectivediseases,ahighdegreeofsuspicionisrequired,basedontheknowledgeofriskfactors,diseasemanifestationsandlocalepidemiologyfortheearlydiagnosisandoptimalmanagementofthesefungalinfectionsConventional methods are still considered as the reference standard for identification of yeast isolates, but they are time-consuming. The chromogenic media, VITEK2 YST card automated system appear to be excellent alternative methods for yeast identification in clinical microbiology laboratories. However, conventional identification methods should be used together with Brilliance Candida agar med chromogenic media iaand VITEK2 YST card to avoid misdiagnosis. Brilliance Candida provided the widest discrimination ability, being able to discriminate five out of the seven Candida species tested. Current study concluded that the most common fungal pathogens causing fungal infections at Assiut University Hospital ICU were Candida and Aspergillus species. Candidemia is the most frequent IFI in ICU patients, while molds IFI remains a sporadic event . Candida albicans was the most commonly isolated yeast from various clinical specimens, also the increase in the resistance especially to azoles is a major concern .Therefore the species level identification of Candida isolates and its sensitivity profile is amust. More importantly this capability will also enable clinicians to choose appropriate antifungal agents ,thus decreasing patients morbidity and mortality. Antifungal susceptibility testing was of great value to exclude ineffective antifungal agents and allow better selection of the most active drugs. Amphotericin B is the agent of choice for disseminated fungal infection. Increasing rate of fluconazole resistance among fungal isolates may be due to frequent use of these agents in the prophylaxis of fungal infections in immunocompromised patients. So, the best approach to the optimal management of fungal infection is early detection and identification of the causal agent, so that appropriate treatment can be initiated as soon as possible in immunocompromised patients. Always to keep in mind the possibility of fungal infection as a cause of patient condition particularly in immunocomprimised patients. Trying to avoid empirical antifungal drugs and treatment should be on basis of in vitro antifungal susceptibility testing to decrease the possibility of emerging drug resist antifungal pathogens. Intensified researches to find out rapid diagnostic techniques that can be applied routinely in clinical settings to improve treatment out comes. More studies have to be directed to understand resistance mechanisms to antifungal drugs and how to overcome this problem using newer drug generations or different drug combinations.