Epidemiologia de Candidemias e perfil de susceptibilidade das leveduras do gênero Candida em Hospital Universitário de Mato Grosso do Sul

Abstract

Studies reveal that fungemias caused by yeasts of the genus Candida has become frequent in medical practice due to its ability to colonize, opportunism and therapeutic challenges assigned to difficult diagnosis and treatment. These infections are associated to risk factors such as the usage of antibiotics for a long time, invasive procedures and surgical techniques, mainly in imunocompromised patients or with severe basis disease. The aim of this study is to estimate the prevalence of Candida spp isolated from blood cultures of patients at the Mato Grosso do Sul University Hospital between 1998 and 2007, as well as to study clinical and epidemiological aspects of candidemia and antifungal susceptibility profile. Detection of yeasts present in the samples was performed by the Bactec® system and the identification of the species by means conventional methods: research of germ tube, auxanograma and microculture. The antifungal susceptibility was determined in broth microdilution technique (M27-A2). In that period 114 cases of Candida spp blood infection were registered, and 61 occurred in male sex. The median age among adult patients was 53 years and among children 36 days. Main risk conditions were: previous use of antibiotics (100%), presence of central venous catheter (82,5%), interning in UTI/CTI (65,8%), use of H2 blockers (64%), parenteral nutrition (57,2%), prior colonization (56,1%), mechanical ventilation (52,6%) and abdominal surgery (29,8%). According to the clinical evolution, 59,6% of the patients died. Candida albicans was the most frequent specie found (47,4%), followed by Candida parapsilosis (32,5%), Candida tropicalis (14,0%), Candida glabrata (5,3%) and Candida krusei (0,9%). There was a significant association between C. glabrata and the realization of abdominal surgery, and between C. tropicalis and the presence of neutropenia and leukemia. Tests of susceptibility to fluconazol, itraconazol and anfotericina B in 103 Candida isolated were done. Among all species the reduction of sensibility to antifungics were rare. Only one strain of C. glabrata was resistant to itraconazol, other 11 were sensitive to dependent dose (9 to itracozaol and 2 to fluconazol). There was no cross-resistance between azoles. All yeasts were susceptible to amphotericin B.