Análise dos casos de candidúria em adultos internados no hospital universitário - UFMS, Campo Grande/MS

Abstract

Candida species are responsible for about 80 % of fungal infections in the hospital environment, affecting the skin, mucous membranes, surgical site, pulmonary tract, urinary tract and the bloodstream. Candiduria is the growth of Candida spp in urine culture, common among patients exposed to risk factors, particularly the ones in the Intensive Care Unit (ICU). It may indicate contamination, colonization, localized and widespread urinary infection or systemic one. The purpose of this study was to analyze cases of candiduria in adults: to identify the species of Candida spp isolates in urine culture, determine the in vitro susceptibility profile to the main antifungals of candiduria and relate the Candida species to demographic variables, admission sector and the results of urianalysis from patients at the University Hospital Center of Maria Aparecida Pedrossian - UFMS, Campo Grande - MS, from May 2011 to April 2012. The patient data were obtained from the laboratory tests results and database of the Medical Mycology - NHU - UFMS. From the positive urine cultures, the identification of species and antifungal susceptibility profile were performed through automated Vitek ® 2, confirmed by cromoágar, auxanogram, microculture in cornmeal agar and micro dilution standard by CLSI M27 - A3 and Supplement 4. A total of 106 candiduria`s cases were reported, highlighting the adult Intensive Care Unit (n=33/31.1%), Emergency Care Unit (n=33/31.1%), Medical clinic (n=20/19.0%) and other sectors (n=20/19.0%). Most patients were female (n=58/54.7%), and age ranged from 19 to 93 years. The most common agent found was C. albicans (39.6%). There was predominated Candida non albicans (CNA=60.4%) considering the sum of the species: C. tropicalis 31.1 %, C. glabrata 17.0%, C. krusei 4,7%, C. parapsilosis complex 3.8 %, C. kefyr 1.9%, C. lusitaniae 0.9% and C. guillermondii 0.9 % . The CNA species were significantly more common in the elderly; C.glabrata was more frequent in patients hospitalized in the Intensive Care Unit (ICU). All species showed a high degree of sensitivity compared to amphotericin B and voriconazole and lack of sensitivity to fluconazole was observed in C.krusei, which is intrinsically resistant. Seventeen samples of C. glabrata were sensitive dose dependent (SDD=94.4%) and the occurrence of a case of resistance to fluconazole by C. glabrata. This study will help in the targeting of the patient therapeutic of the hospital studied and will help to compose the national and global overview of Candida spp involved in the candiduria of the inpatients as well as its resistance profile .