Perfil epidemiológico de pacientes com candidemias em 11 hospitais de Manaus e avaliação da susceptibilidade aos antifúngicos e fatores de virulência de Candida spp.

Abstract

Candidemia is an infection recognized as public health problem related to health assistance. Filling the knowledge gaps through epidemiological studies and diagnostic tools to respond emerging threats that may be involved in the disease process is among the actions to eliminate these infections. The objective of this research was to study the Candida yeasts isolated from blood cultures of patients admitted in 11 hospitals of Manaus in 2013, as well to study the clinical epidemiological aspects of candidemia, the antifungal profile of susceptibility and virulence factors. The detection of yeasts in the collected samples was performed by conventional methodology. The antifungal susceptibility was determined using E-Test® strips. The studied virulence factors were proteinase, phospholipase, hemolysin and biofilm formation. During the study period, there were 85 cases of infection in the blood of 81 patients with Candida spp. In relation to gender, 67.9% were male, the median age of adult patients was 53 years and between pediatric patients was 60 days. The main risk conditions were: previous use of antibiotics (98.6%), presence of central venous catheter (95.9%), ICU (84.9%), use of protectors of gastric mucosa (84.4 %) and one-third of patients are from natal care and 72.8% of patients had up to 1 year old. According to the clinical course of patients, 40.7% died. C. albicans was the most frequently isolated species (34.57%), followed by C. tropicalis (32.1%) and Candida parapsilosis (17.28%). A susceptibility test was performed against Caspofungin, Micafungin, and Voriconazole, where the resistance 12.1%, 4.3% and 4.3% was respectively found. The virulence factors related to production of enzymes was: Proteinase with 56.4% of the isolates being producers, Phospholipase 36.2% and 78.7% hemolysin with this capability being more expressive in the species C. albicans. The biofilm formation was present in 34% of the isolates whose C. tropicalis was the most significant in this factor. The importance of epidemiology studies and local phenotypic studies may contribute to improve decision-making process and propose more effective measures for control and prevention of these infections.