Nikhil Kulkarni
Jupiter Lifeline Hospitals, India
Title: Fungal Urosepsis in a susceptible preterm baby presenting with acute renal failure
Biography
Biography: Nikhil Kulkarni
Abstract
A 41days female infant presented with h/o refused feeds, fever, convulsions, hypotension, decreased urine output,admitted outside for same complaints for 3 days then referred .Birth History: PT, 32 weeks, RDS, LBW, received Surfactant and CPAP ventilation for 6 days .Child was drowsy with generalized abdominal distension and no urine output in past 24 hours.RFTs were grossly derranged with high BUN,Creatinine & Potassium.Blood & Urine Cultures sent.USG Abdopelvis suggested Gross B/L Hydronephrosis with both Ureters not visualized, Bladder collapsed, Ascites with debris in pelvicalyceal regions.Suspecting Fungal Urosepsis,started on Inj Fluconazole and Piptaz,transfused with PRBC, FFP and prepared for Peritoneal Dialysis,intubated and PD was started.Percutaneous Nephrostomy Tubes were inserted bilaterally under USG guidance,urine samples from tubes also sent for culture and Irrigation of Fluconazole through PCN was started along with Inj Fungisome therapy.PD was stopped after 4 days as hemodynamics and RFT improved.Urine Cultures grew Candida albicans,sensitive to Fluconazole.Extubated and weaned off respiratory support, started on feeds as tolerated, fluids tapered.Urine culture after 2 weeks showed E. Coli growth(>1,00,000 CFU) , Inj Tigecycline and Collistin added as per sensitivity.Gradually, due to decreasing output from PCNs and repeat USG showing clearing of fungal pus pockets from PC systems,PCNs were clamped and removed.Repeat Urine Culture showed no growth.Baby was given Inj Fluconazole for 42 days, Inj Colistin & Inj Tigecycline for 14 days, on full feeds with adequate per urethral urine output, hemodynamically stable, with normal RFT, latest Urine Cultures showing no growth, good weight gain on follow up.