RESUMO
OBJECTIVES: Candida spp. is an opportunistic pathogen that causes superficial and invasive infections with nosocomial outbreaks without strict hygiene protocols. Herein, we assessed oral colonisation by Candida spp. in 209 Intensive Care Unit (ICU) patients between July 2021 and April 2022, conducting clinical, epidemiological, and microbiological characterisation of those developing oral or invasive candidiasis. METHODS: Initial oral swabs were collected within 24 h of admission in the ICU, followed by collections on Days 2, 4, 6 and 8. Swabs from denture-wearing patients, abiotic surfaces, healthcare professionals' hands, and retroauricular regions were also obtained. Recovered yeasts and filamentous fungi were identified using MALDI-TOF MS and morphological characteristics, respectively. Genetic similarity of Candida spp. isolates was evaluated using Amplified fragment length polymorphism (AFLP), and the antifungal susceptibility profile was determined by broth microdilution. RESULTS: In the study, 64.11% of patients were orally colonised by Candida spp. Of these, 80.59% were colonised within the first 24 h. Oral colonisation also occurred on subsequent days: 50%/Day 2, 26.92%/Day 4, and 11.53%/Days 6 and 8. Of the patients, 8.61% had oral candidiasis, mainly pseudomembranous. Among orally colonised patients, 2.23% developed invasive candidiasis. Besides, 89.47% of healthcare professionals evaluated were colonised. MALDI-TOF MS identified different yeast species, and C. albicans (45.34%), C. tropicalis (15.7%), and C. parapsilosis sensu stricto (9.88%) were the most prevalent. AFLP analysis indicated a high genetic correlation (≥97%) between C. parapsilosis sensu stricto isolates from patients and professionals. Three resistant C. albicans isolates were also found. CONCLUSION: This study reported a diversity of yeast and filamentous fungi species in ICU patients and highlighted early Candida spp. colonisation risks for invasive candidiasis, as well as the potential horizontal transmission in the nosocomial setting, emphasising the need for effective infection control measures.
Assuntos
Candida , Pessoal de Saúde , Unidades de Terapia Intensiva , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Candida/genética , Candida/isolamento & purificação , Candida/efeitos dos fármacos , Candida/classificação , Idoso , Adulto , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Infecção Hospitalar/microbiologia , Infecção Hospitalar/epidemiologia , Testes de Sensibilidade Microbiana , Candidíase Bucal/microbiologia , Candidíase Bucal/epidemiologia , Candidíase Invasiva/microbiologia , Candidíase Invasiva/epidemiologia , Idoso de 80 Anos ou mais , Análise do Polimorfismo de Comprimento de Fragmentos Amplificados , Boca/microbiologiaRESUMO
INTRODUCTION: Neonatal Candida spp. infections are serious events due to their morbidity and mortality, however, epidemiological information is insufficient in developing countries. The objective of this study was to describe the incidence and factors associated with invasive infection by Candida spp. in a Neonatal Intensive Care Unit in Mexico. METHODS: Case-control study nested in a cohort and matched for birth weight. We estimated the incidence of invasive neonatal infection by Candida spp. For the bivariate analysis of the studied factors, McNemar's test was used to contrast hypotheses and multivariate analysis was made with logistic regression. RESULTS: The incidence of infection was 2.27 events/1000 live newborns. The species identified were C. albicans 35.3% (n 30), C. parapsilosis 30.6% (n 26), C. glabrata 31.8% (n 27) and two events with C. lipolytica. The factors associated with a higher risk were mechanical ventilation (OR 3.04, 95% CI 1.13-8.14), systemic antibiotics (OR 7.48, 95% CI 1.30-42.9), number of antimicrobial regimens (OR 2.02, 95% CI 1.01-4.03), and days with total parenteral nutrition (OR 1.14, 95% CI 1.04-1.25) or with venous catheter central (OR 1.11, 95% CI 1.02-1.20). Fluconazole prophylaxis decreased the risk (OR 0.32, 95% CI 0.12-0.84). CONCLUSIONS: Invasive interventions (central catheter, mechanical ventilation, and parenteral nutrition) and the use of antimicrobials increase the risk of neonatal Candida spp. Infection, while prophylactic fluconazole is protective.
Assuntos
Candidíase Invasiva , Fluconazol , Antifúngicos/uso terapêutico , Candida , Candida albicans , Candidíase , Candidíase Invasiva/tratamento farmacológico , Candidíase Invasiva/epidemiologia , Estudos de Casos e Controles , Fluconazol/uso terapêutico , Humanos , Incidência , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , México/epidemiologiaRESUMO
Abstract Objectives: to describe the epidemiology of invasive candidiasis in a neonatal intensive care unit. Methods: cross-sectional study that included all neonates with invasive candidiasis confirmed by blood culture from April 2015 to June 2018. Demographic, clinical and microbiological data were analyzed, comparing neonates with extreme low birth weight (ELBW) with neonates ≥ 1000g birth weight, considering a p <0.05 as statistically significant. Results: there were 38 cases of invasive candidiasis, resulting in an overall incidence of 2.5%. Twelve (32%) were ELBW neonates and 26 (68%) neonates ≥ 1000g birth weight, an incidence of 4.4% and 2.0%, respectively. Abdominal surgery was more frequent among neonates with birth weight ≥ 1000g compared to ELBW neonates (85% vs. 17%; p <0.01), as well as the median in days of antibiotics use (18 vs. 10.5; p = 0.04). The median in days of mechanical ventilation was more frequent among ELBW neonates (10 vs. 5.5; p = 0.04). The majority of Candida species were non-albicans (64%). Fatality rate was 32%. Conclusions: the incidence of invasive candidiasis among neonates with birth weight ≥ 1000g was higher than that found in the literature. This group has a higher proportion of gastrointestinal malformations that require surgery. Thus, fluconazole prophylaxis may be necessary for a broader group of neonates.
Resumo Objetivos: descrever a epidemiologia de candidíase invasiva em uma unidade de terapia intensiva neonatal. Métodos: estudo transversal que incluiu todos recém-nascidos com candidíase invasiva confirmada por hemocultura de abril de 2015 a junho de 2018. Foi analisado dados demográficos, clínicos e microbiológicos, comparando recém-nascidos de extremo baixo peso ao nascer (EBPN) com os recém-nascidos com peso ao nascer ≥1000g, considerando um valor de p<0,05 como estatisticamente significativo. Resultados: houve 38 casos de candidíase invasiva, resultando em uma incidência global de 2,5%. Doze (32%) eram neonatos de EBPN e 26 (68%) neonatos com peso ao nascer ≥1000g, resultando em uma incidência de 4,4% e 2,0%, respectivamente. A realização de cirurgia abdominal foi mais frequente nos neonatos com peso ao nascer ≥1000g em comparação com os neonatos de EBPN (85% vs. 17%; p<0,01), assim como a mediana dos dias de uso de antibióticos (18 vs. 10,5; p =0,04). Já o a mediana dos dias de ventilação mecânica foi mais frequente entre recém-nascido de EBPN (10 vs. 5,5; p = 0,04). A maioria das espécies de Candida eram não-albicans (64%). A letalidade foi de 32%. Conclusões: a incidência de candidíase invasiva entre os recém-nascidos ≥1000g ao nascer foi superior ao encontrado na literatura. Este grupo tem uma maior proporção de malformações gastrointestinais que requerem cirurgia. Assim, a profilaxia com fluconazol pode ser necessária para um grupo mais amplo de recém-nascidos.
Assuntos
Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Fluconazol/uso terapêutico , Candidíase Invasiva/prevenção & controle , Candidíase Invasiva/terapia , Candidíase Invasiva/epidemiologia , Atenção Terciária à Saúde , Peso ao Nascer , Brasil/epidemiologia , Estudos Transversais , Recém-Nascido de Peso Extremamente Baixo ao NascerRESUMO
An increasing number of outbreaks due to resistant non-albicans Candida species have been reported worldwide. Between 2014 and 2016, Candida isolates causing invasive candidiasis were recovered in a Mexican hospital. Isolates were identified to species level and antifungal susceptibility was determined. In the time period studied, 74 invasive candidiasis cases were identified, with 38% (28/74) caused by Candida parapsilosis, out of which 54% (15/28) were fluconazole resistant. The ERG11 gene was sequenced for 12 recoverable fluconazole-resistant C. parapsilosis isolates and SNPs identified. The 12 isolates had one common silent point mutation in ERG11 (T591C) and seven isolates had an additional (A395T) mutation, which corresponded to Y132F. Four of the isolates carrying this mutation were closely related within the same cluster by microsatellite typing. This is the first report of an invasive candidiasis outbreak in Mexico due to azole-resistant C. parapsilosis associated with the Y132F substitution.
Assuntos
Antifúngicos/farmacologia , Azóis/farmacologia , Candida parapsilosis/efeitos dos fármacos , Candida parapsilosis/genética , Candidíase Invasiva/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Proteínas Fúngicas/genética , Mutação/efeitos dos fármacos , Adulto , Substituição de Aminoácidos , Farmacorresistência Fúngica , Feminino , Hospitais Gerais/estatística & dados numéricos , Humanos , Masculino , México , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Mutação/genética , Estudos RetrospectivosAssuntos
Candida/isolamento & purificação , Candidíase Invasiva/prevenção & controle , Surtos de Doenças/prevenção & controle , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Candida/classificação , Candida/efeitos dos fármacos , Candidíase Invasiva/tratamento farmacológico , Candidíase Invasiva/epidemiologia , Candidíase Invasiva/microbiologia , Colômbia/epidemiologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/prevenção & controle , Erros de Diagnóstico , Desinfetantes/farmacologia , Desinfecção , Farmacorresistência Fúngica Múltipla , Microbiologia Ambiental , Contaminação de Equipamentos , Higiene das Mãos , Humanos , Controle de Infecções , Técnicas de Tipagem Micológica , Pele/microbiologiaRESUMO
Invasive candidiasis (IC) is the most frequent health care associated invasive fungal infection. It is also associated with high morbidity, mortality, and cost. The most frequent etiologic agent is Candida albicans, but non-albicans species are increasing and associated with reduced antifungal susceptibility and outbreaks. Candida auris is an emerging multidrug-resistant species recently described. IC presents as a spectrum of disease, going from fungemia to deep-seated candidiasis, and to septic shock with multiorgan failure. Diagnosis of IC is challenging. Several biomarkers and molecular methods are available for improving diagnosis. Early initial treatment with echinocandins is the treatment of choice. Step-down therapy when antifungal susceptibility is available is possible. Several new antifungal agents for the treatment of IC are in clinical development.
Assuntos
Antifúngicos/uso terapêutico , Candidíase Invasiva/tratamento farmacológico , Candidíase Invasiva/epidemiologia , Candida/efeitos dos fármacos , Candidíase Invasiva/microbiologia , Farmacorresistência Fúngica Múltipla , Equinocandinas/uso terapêutico , Humanos , Testes de Sensibilidade MicrobianaRESUMO
BACKGROUND: Neutropenic patients developing acute disseminated candidiasis may present with skin lesions. AIMS: To evaluate the epidemiology of acute disseminated candidiasis with skin lesions in neutropenic patients, taking into consideration changes caused by different prophylactic strategies. SOURCES: A systematic review of English-language articles found via PubMed (1963-2016) was performed. We asked the following questions: (a) What Candida species are more frequently involved in this syndrome? (b) Has antifungal prophylaxis changed the species causing skin lesions? (c) What are the typical patterns of skin lesions? (d) What is the frequency of skin lesions in neutropenic patients with candidaemia or acute disseminated candidiasis? (e) Has antifungal prophylaxis decreased the incidence of acute disseminated candidiasis with skin lesions? CONTENT: Among 183 studies, 33 were selected, reporting 100 cases of acute disseminated candidiasis with skin lesions in neutropenic patients. It occurred more frequently in the setting of induction therapy for de novo or relapsed acute leukaemia, and the most frequent Candida species were C. tropicalis (68%) and C. krusei (15%). Diffuse maculopapular lesions predominated in cases caused by C. tropicalis and nodular and papular lesions in cases caused by C. krusei. Prophylaxis with fluconazole was reported in six cases, C. krusei in five and C. ciferrii in one. The death rate was 45.4%. IMPLICATIONS: Two patterns were recognized: disseminated maculopapular lesions caused by C. tropicalis in patients not receiving fluconazole prophylaxis, occurring in 39% to 44% of neutropenic patients with acute disseminated candidiasis, and nodular lesions caused by C. krusei in patients receiving fluconazole prophylaxis, occurring less frequently.
Assuntos
Candida/classificação , Candida/isolamento & purificação , Candidíase Invasiva/patologia , Neutropenia/complicações , Pele/patologia , Antifúngicos/administração & dosagem , Candidíase Invasiva/epidemiologia , Candidíase Invasiva/prevenção & controle , Quimioprevenção/estatística & dados numéricos , Humanos , Hospedeiro ImunocomprometidoRESUMO
This study presents a systematic review of the literature on the etiology of superficial and invasive candidiasis in Mexico reported from 2005 to 2015. The data have shown that Candida albicans is the most prevalent species with an increasing tendency of the non-C. albicans Candida species, as reported in other countries. The use of phenotypical methods in the identification of the yeasts limits the identification at the species level, particularly in species that are part of complexes, this is important because the identification only at the genus level leads to inadequate treatment due to the different susceptibility to the antifungals among species. In addition, this finding reveals the need to implement in clinical laboratories the molecular methods for the correct identification of the species involved, and the antifungal susceptibility tests to prevent the etiological changes associated with a poor therapeutic management.
Assuntos
Candida/isolamento & purificação , Candidíase/epidemiologia , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Candida/classificação , Candida/patogenicidade , Candidíase/tratamento farmacológico , Candidíase/microbiologia , Candidíase Invasiva/epidemiologia , Candidíase Invasiva/microbiologia , Comorbidade , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Gerenciamento Clínico , Suscetibilidade a Doenças , Farmacorresistência Fúngica Múltipla , Humanos , México/epidemiologia , Técnicas de Tipagem Micológica , Infecções Oportunistas/tratamento farmacológico , Infecções Oportunistas/epidemiologia , Infecções Oportunistas/microbiologia , Especificidade da EspécieRESUMO
Introducción: en los últimos años ha aumentado la incidencia de candidiasis invasiva (CI) a nivel mundial. En nuestro país no se disponen de estudios epidemiológicos sobre CI. El objetivo fue determinar incidencia de CI en la Unidad de Cuidados Intensivos de Niños del Centro Hospitalario Pereira Rossell. Metodología: estudio descriptivo retrospectivo. Se incluyeron los niños con CI hospitalizados entre 1/1/2009-1/6/2014. A partir de los cultivos micológicos se identificaron las historias clínicas de los pacientes que desarrollaron CI. Se definió CI al aislamiento de Candida en algún sitio estéril. Se calcularon la densidad de incidencia y de prevalencia. Se registró motivo de ingreso y presencia de factores de riesgo para CI. Resultados: se identificaron 6 casos de CI, incidencia de 1,86 c/1000 ingresos. Los aislamientos se realizaron en hemocultivos (n=3) y líquido peritoneal (n=3). Las especies de Candida aisladas fueron C. albicans (n=3), C. parapsilosis (n=2) y C. tropicalis (n=1). Los factores de riesgo para CI presentes fueron dispositivos invasivos (n=6), antibióticos de amplio espectro (n=6), alimentación parenteral (n=5), cirugía abdominal(n=4). Todos los aislamientos fueron sensibles a los azoles. En 1 de las 6 CI se inició tratamiento empírico previo al aislamiento. Fallecieron 4 de los 6 pacientes. Discusión: la incidencia fue similar a otra experiencia realizada en cuidados intensivos pediátricos. Los pacientes que desarrollaron CI presentaron asociación de factores de riesgo. Los aislamientos fueron sensibles a fluconazol. Caracterizar a estos niños permitirá iniciar en forma oportuna el tratamiento antifúngico. Se destaca la importancia de desarrollar la vigilancia continua sobre las especies de Candida y su patrón de sensibilidad a los antifúngicos.
Introduction: invasive infections by Candida strains have increased around the world in the last years. There are no epidemiological studies on invasive candidiasis (IC) in Uruguay. The study aimed to find out the incidence of IC in the Pediatric Intensive Care Unit (PICU) at the Pereira Rossell Hospital Center (CHPR). Method: a retrospective and descriptive study was conducted. Children hospitalized in PICU of the CHPR between 1/1/2009 and 1/6/2014 were included in the study. The medical records of patients who developed IC were identified based on mycological cultures. Invasive candidiasis was defined as the isolation of the fungus in a sterile site. Incidence and prevalence density were calculated. Cause for hospitalization and risk factors for IC were recorded. Results: six cases of IC were identified and the incidence was of 1.86/1000 hospitalized children in PICU. Isolation of Candida was done in blood cultures (n=3) and peritoneal fluid (n=3). The species of Candida isolated were C. albicans (n=3), C.parapsilosis (n=2) and C. tropicalis (n=1). Risk factors for IC were identified in the 6 cases. Use of invasive prosthesis and a wide spectrum antibiotics were identified in the 6 cases, as well as parenteral nutrition (n=5) and abdominal surgery (n=4). All isolations of Candida were sensitive to fluconazole. Antifungal empiric treatment was started in one case prior to the isolation of Candida. Four out of six children died. Discussion: the incidence of IC found was similar to that in another study in a PICU. Children who developed IC presented several risk factors for IC. The 6 isolations of Candida were sensitive to fluconazole. Analyzing the clinical features of these children will allow the identification of patients with high risk of IC and to timely initiate antifungal treatment. It is necessary to maintain a continuous surveillance on Candida species and their sensitivity pattern to antifungal medication.
Assuntos
Humanos , Candidíase Invasiva/etiologia , Candidíase Invasiva/epidemiologia , Uruguai , Unidades de Terapia Intensiva Pediátrica , Criança Hospitalizada , Epidemiologia Descritiva , Incidência , Prevalência , Estudos Retrospectivos , Fatores de Risco , Candidíase Invasiva , Candidíase Invasiva/mortalidade , Antifúngicos/uso terapêuticoRESUMO
Introducción: en los últimos años ha aumentado la incidencia de candidiasis invasiva (CI) a nivel mundial. En nuestro país no se disponen de estudios epidemiológicos sobre CI. El objetivo fue determinar incidencia de CI en la Unidad de Cuidados Intensivos de Niños del Centro Hospitalario Pereira Rossell. Metodología: estudio descriptivo retrospectivo. Se incluyeron los niños con CI hospitalizados entre 1/1/2009-1/6/2014. A partir de los cultivos micológicos se identificaron las historias clínicas de los pacientes que desarrollaron CI. Se definió CI al aislamiento de Candida en algún sitio estéril. Se calcularon la densidad de incidencia y de prevalencia. Se registró motivo de ingreso y presencia de factores de riesgo para CI. Resultados: se identificaron 6 casos de CI, incidencia de 1,86 c/1000 ingresos. Los aislamientos se realizaron en hemocultivos (n=3) y líquido peritoneal (n=3). Las especies de Candida aisladas fueron C. albicans (n=3), C. parapsilosis (n=2) y C. tropicalis (n=1). Los factores de riesgo para CI presentes fueron dispositivos invasivos (n=6), antibióticos de amplio espectro (n=6), alimentación parenteral (n=5), cirugía abdominal(n=4). Todos los aislamientos fueron sensibles a los azoles. En 1 de las 6 CI se inició tratamiento empírico previo al aislamiento. Fallecieron 4 de los 6 pacientes. Discusión: la incidencia fue similar a otra experiencia realizada en cuidados intensivos pediátricos. Los pacientes que desarrollaron CI presentaron asociación de factores de riesgo. Los aislamientos fueron sensibles a fluconazol. Caracterizar a estos niños permitirá iniciar en forma oportuna el tratamiento antifúngico. Se destaca la importancia de desarrollar la vigilancia continua sobre las especies de Candida y su patrón de sensibilidad a los antifúngicos.
Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Candidíase Invasiva/epidemiologia , Candidíase Invasiva/etiologia , Candidíase Invasiva/tratamento farmacológico , Candidíase Invasiva/mortalidade , Incidência , Prevalência , Unidades de Terapia Intensiva Pediátrica , Epidemiologia Descritiva , Estudos Retrospectivos , Criança Hospitalizada , Fatores de Risco , Antifúngicos/uso terapêutico , UruguaiRESUMO
INTRODUCTION: Invasive fungal disease (IFD) is an important complication after solid organ transplantation (SOT). A marked geographic variation in the epidemiology of IFD after kidney transplantation (KT) has been suggested by the results of previous studies. Nevertheless, data from Latin American centers are scarce. OBJECTIVE: This study sought to describe the epidemiology of IFD at a Brazilian KT center. METHODS: This study was a retrospective single-center cohort study that included patients who underwent KT between 1998 and 2009 and were followed up until July 2015. Cases of simultaneous kidney-pancreas transplantation were excluded. The primary study outcome was the occurrence of proven or probable IFD. RESULTS: Among 908 KT recipients, 44 cases of IFD occurred in 42 patients (4.6%). Cryptococcus spp. infection, diagnosed in 16 cases (36.3%), was the leading cause of IFD, followed by histoplasmosis in 10 cases (22.7%) and invasive candidiasis in 10 (22.7%). Sporotrichosis, mucormycosis, invasive aspergillosis, pulmonary Cladophialophora sp. infection, trichosporonosis and Saccharomyces cerevisiae fungemia occurred in 1 recipient each (2.3%). Two additional (4.5%) cases of unspecified mold infections were identified by histopathological analysis. Most cases of IFD (67%) occurred later than 6 months after transplantation. Previous use of antilymphocyte antibodies (P = .008) and corticosteroid pulse therapy (P < .001) were more frequent among cases of IFD occurring within the first 6 months after transplantation. CONCLUSIONS: The epidemiology of IFD in this Brazilian cohort was characterized by a large predominance of late infections and a high proportion of cases of cryptococcosis and histoplasmosis. These results highlight the considerable geographic variability of IFD epidemiology after KT.
Assuntos
Soro Antilinfocitário/uso terapêutico , Rejeição de Enxerto/prevenção & controle , Imunossupressores/uso terapêutico , Transplante de Rim , Micoses/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Brasil/epidemiologia , Candidíase Invasiva/epidemiologia , Criptococose/epidemiologia , Feminino , Histoplasmose/epidemiologia , Humanos , Aspergilose Pulmonar Invasiva/epidemiologia , Masculino , Pessoa de Meia-Idade , Mucormicose/epidemiologia , Estudos Retrospectivos , Fatores de Risco , TransplantadosRESUMO
Yeasts of the genus Candida have high genetic variability and are the most common opportunistic pathogenic fungi in humans. In this study, we evaluated the genetic diversity among 120 isolates of Candida spp. obtained from diabetic patients, kidney transplant recipients and patients without any immune deficiencies from Paraná state, Brazil. The analysis was performed using the ITS1-5.8S-ITS2 region and a partial sequence of 28S rDNA. In the phylogenetic analysis, we observed a consistent separation of the species C. albicans, C. dubliniensis, C. glabrata, C. tropicalis, C. parapsilosis, C. metapsilosis and C. orthopsilosis, however with low intraspecific variability. In the analysis of the C. albicans species, two clades were formed. Clade A included the largest number of isolates (91.2%) and the majority of isolates from GenBank (71.4%). The phylogenetic analysis showed low intraspecific genetic diversity, and the genetic polymorphisms between C. albicans isolates were similar to genetic divergence found in other studies performed with isolates from Brazil. This low genetic diversity of isolates can be explained by the geographic proximity of the patients evaluated. It was observed that yeast colonisation was highest in renal transplant recipients and diabetic patients and that C. albicans was the species most frequently isolated.
Assuntos
Humanos , Masculino , Feminino , Candida/genética , Candidíase Invasiva/genética , Diabetes Mellitus/microbiologia , Variação Genética , Transplante de Rim , Brasil/epidemiologia , Candida/classificação , Candida/isolamento & purificação , Candidíase Invasiva/classificação , Candidíase Invasiva/epidemiologia , Candidíase Invasiva/microbiologia , Estudos de Casos e Controles , Complicações do Diabetes , DNA Fúngico/análise , DNA Ribossômico/genética , Testes de Sensibilidade MicrobianaRESUMO
Yeasts of the genus Candida have high genetic variability and are the most common opportunistic pathogenic fungi in humans. In this study, we evaluated the genetic diversity among 120 isolates of Candida spp. obtained from diabetic patients, kidney transplant recipients and patients without any immune deficiencies from Paraná state, Brazil. The analysis was performed using the ITS1-5.8S-ITS2 region and a partial sequence of 28S rDNA. In the phylogenetic analysis, we observed a consistent separation of the species C. albicans, C. dubliniensis, C. glabrata, C. tropicalis, C. parapsilosis, C. metapsilosis and C. orthopsilosis, however with low intraspecific variability. In the analysis of the C. albicans species, two clades were formed. Clade A included the largest number of isolates (91.2%) and the majority of isolates from GenBank (71.4%). The phylogenetic analysis showed low intraspecific genetic diversity, and the genetic polymorphisms between C. albicans isolates were similar to genetic divergence found in other studies performed with isolates from Brazil. This low genetic diversity of isolates can be explained by the geographic proximity of the patients evaluated. It was observed that yeast colonisation was highest in renal transplant recipients and diabetic patients and that C. albicans was the species most frequently isolated.
Assuntos
Candida/genética , Candidíase Invasiva/genética , Diabetes Mellitus/microbiologia , Variação Genética , Transplante de Rim , Brasil/epidemiologia , Candida/classificação , Candida/isolamento & purificação , Candidíase Invasiva/classificação , Candidíase Invasiva/epidemiologia , Candidíase Invasiva/microbiologia , Estudos de Casos e Controles , DNA Fúngico/análise , DNA Ribossômico/genética , Complicações do Diabetes , Feminino , Humanos , Masculino , Testes de Sensibilidade MicrobianaRESUMO
BACKGROUND: Hemodialysis has been described as an important risk factor for the development of candidemia in patients suffering from chronic renal failure. AIMS: The aim of this study was to evaluate the epidemiology of candidemia in outpatients with renal replacement therapy (RRT) by hemodialysis where the fungemia clearly represents a healthcare-associated infection. METHODS: We retrospectively collected clinical and laboratory data from patients undergoing at least 3 months of RRT by hemodialysis who developed candidemia within 48h of hospital admission. RESULTS: We identified 14 patients with candidemia with central venous catheters (CVC) in place for 11-277 days before developing fungemia. Deep-seated infection was documented in 6 out of 14 candidiasis cases (43%), including 5 cases of endocarditis (36%). CONCLUSIONS: CVC in patients under RRT should be promptly replaced by fistulas and grafts to avoid bloodstream infections. Facing a case of candidemia, adequate source control and prompt initiation of antifungal therapy are mandatory to avoid morbidity and mortality.
Assuntos
Candidíase Invasiva/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Venoso Central/efeitos adversos , Infecção Hospitalar/epidemiologia , Diálise Renal/efeitos adversos , Adulto , Idoso , Brasil/epidemiologia , Candidemia/epidemiologia , Candidemia/etiologia , Candidemia/microbiologia , Candidíase Invasiva/etiologia , Candidíase Invasiva/microbiologia , Infecções Relacionadas a Cateter/etiologia , Infecções Relacionadas a Cateter/microbiologia , Cateteres Venosos Centrais/efeitos adversos , Cateteres Venosos Centrais/microbiologia , Infecção Hospitalar/etiologia , Infecção Hospitalar/microbiologia , Suscetibilidade a Doenças , Endocardite/epidemiologia , Endocardite/etiologia , Endocardite/microbiologia , Endoftalmite/epidemiologia , Endoftalmite/etiologia , Endoftalmite/microbiologia , Infecções Oculares Fúngicas/epidemiologia , Infecções Oculares Fúngicas/etiologia , Infecções Oculares Fúngicas/microbiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Diálise Renal/métodos , Estudos Retrospectivos , Fatores de Tempo , Adulto JovemRESUMO
Candida is the most important agent of fungal infections. Several risk factors have been described associated with invasive infection by fluconazole-resistant Candida spp. A prospective cross-sectional study with case-control analysis was conducted. Case group patients with fluconazole-resistant Candida isolate were included; control group were patients with fluconazole-susceptible Candida spp. A multivariate logistic regression model was performed. Three hundred isolates of Candida spp. were analyzed. Most frequent species were Candida albicans/Candida dubliniensis (48.3%) and Candida tropicalis (22.3%). Posaconazole susceptibility was 93.7%; voriconazole, 84%; and fluconazole, 78.7%. Susceptibility to anidulafungin and caspofungin was 92.7% and 92.3%, respectively. Neutropenia (adjusted odds ratio [aOR] 6.5, 95% confidence interval [CI] 1.0-43.1), antifungal exposure (aOR 5.1, 95% CI 2.3-11.2), and antituberculosis therapy (aOR 7.7, 95% CI 1.4-43.2) were associated to fluconazole resistance. Susceptibility results are useful to guide the selection of empiric antifungal treatment and the design of local therapeutic guidelines. Previous antifungal exposure suggests possible resistance to fluconazole, pointing towards the selection of a different class of antifungal agents.
Assuntos
Antifúngicos/farmacologia , Candida/efeitos dos fármacos , Candidíase Invasiva/epidemiologia , Candidíase Invasiva/microbiologia , Farmacorresistência Fúngica , Fluconazol/farmacologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Candida/classificação , Candida/isolamento & purificação , Estudos de Casos e Controles , Criança , Pré-Escolar , Colômbia/epidemiologia , Estudos Transversais , Demografia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Adulto JovemRESUMO
OBJECTIVE: To investigate prevalence of invasive candidiasis in a Neonatal Intensive Care Unit and to evaluate oral diseases and Candida spp. colonization in low birth weight preterm newborns. METHODS: A descriptive epidemiological study performed in two stages. First, prevalence of candidiasis was analyzed in a database of 295 preterm patients admitted to hospital for over 10 days and birth weight less than 2,000g. In the second stage, oral changes and Candida spp. colonization were assessed in 65 patients weighing less than 2,000g, up to 4 week-old, hospitalized for over 10 days and presenting oral abnormalities compatible with fungal lesions. Swab samples were collected in the mouth to identify fungi. RESULTS: Prevalence of candidiasis was 5.4% in the database analyzed. It correlated with prolonged hospital length of stay (p<0.001), in average, 31 days, and 85% risk of developing infection in the first 25 days. It correlated with low birth weight (p<0.001), with mean of 1,140g. The most frequent alterations were white soft plaques, detachable, in oral mucosa and tongue. Intense oral colonization by Candida spp was observed (80%). CONCLUSIONS: The frequency of invasive candidiasis was low and correlated with low birth weight and prolonged hospital stay. The most common oral changes were white plaques compatible with pseudomembranous candidiasis and colonization by Candida spp. was above average.
Assuntos
Candida/crescimento & desenvolvimento , Candidíase Invasiva/epidemiologia , Candidíase Bucal/epidemiologia , Doenças do Prematuro/epidemiologia , Boca/microbiologia , Peso ao Nascer , Brasil/epidemiologia , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Tempo de Internação , Masculino , Boca/patologia , Prevalência , Fatores de Risco , Fatores de TempoRESUMO
The aim of this study was to isolate yeasts from the faeces of urban bats inhabiting the city of Londrina, Paraná, Brazil and to determine their potential virulence attributes. Seven (12.3%) of 57 bats screened in this study showed yeasts in their faeces. Five species of the genus Candida were isolated: C. guilliermondii, C. krusei, C. lusitaniae, C. parapsilosis, and C. pelliculosa. No phospholipase activity was detected in the egg yolk plate assay; however, all isolates demonstrated protease secretion in skim milk agar. Yeasts isolated from bats produced biofilm on the surface of polystyrene plates and all were classified as intermediate biofilm producers. Minimal inhibitory concentration (MIC) values for fluconazole in the yeasts varied according to the species. Only one isolate (M34 - C. lusitaniae) was considered susceptible dose-dependent to fluconazole. The yeasts were injected intravenously into Swiss mice, and at 15 days post-infection, the animals were killed and portions of their kidneys cultured on Sabouraud dextrose agar medium. All tissues analysed showed positive cultures of Candida spp. This is the first study evaluating the presence of fungi in the faeces of bats in an urban region, where the yeast species found were shown to be potentially pathogenic. As bats are commonly found in cities, these findings indicate the need for continuous surveillance concerning environmental contamination by their excreta.
Assuntos
Antifúngicos/farmacologia , Candida/isolamento & purificação , Candidíase Invasiva/veterinária , Quirópteros/microbiologia , Fezes/microbiologia , Fluconazol/farmacologia , Animais , Biofilmes/crescimento & desenvolvimento , Brasil/epidemiologia , Candida/efeitos dos fármacos , Candida/patogenicidade , Candidíase Invasiva/epidemiologia , Candidíase Invasiva/microbiologia , Cidades , Contagem de Colônia Microbiana , Humanos , Rim/microbiologia , Masculino , Camundongos , Testes de Sensibilidade Microbiana , Modelos Animais , Peptídeo Hidrolases/metabolismo , Fosfolipases/metabolismo , Fatores de Risco , VirulênciaRESUMO
Invasive infections by Candida strains are a relevant pathology in critically ill patients. Candida should be considered where a high risk of infection is present for a critical early diagnosis. Despite the incorporation of new drugs in the therapeutic armamentarium over the last decade, mortality remains high. The key in improving clinical outcomes of these patients are the use of early effective therapies that offer coverage against different strains of Candida: C. albicans and non-albicans. Recent international guidelines suggest empiric therapy with echinocandins in suspected invasive candidiasis in this patient population. This group of drugs adequately documented clinical efficacy and safe use in these patients. The emergence of new echinocandins could improve access to these drugs by reducing their cost.
Assuntos
Candidíase Invasiva , Adulto , Antifúngicos/uso terapêutico , Candidíase Invasiva/diagnóstico , Candidíase Invasiva/tratamento farmacológico , Candidíase Invasiva/epidemiologia , Estado Terminal , Humanos , Unidades de Terapia Intensiva , Fatores de RiscoRESUMO
Las infecciones invasoras por Candida spp, representan una patología relevante en los pacientes críticos. Para su oportuno diagnóstico es necesaria una elevada sospecha clinica, tomando en consideración el cuadro clinico y la presencia de factores de riesgo. Pese a la incorporación de nuevos fármacos al arsenal terapéutico durante la última década, mantiene una elevada mortalidad. Las claves para mejorar los desenlaces clínicos en estos pacientes son el empleo de una terapia precoz, eficaz y que permita la cobertura de distintas especies de Candida: C albicans y no albicans. Recientes guías internacionales sugieren la terapia empírica con equinocandinas ante la sospecha de candidiasis invasora en esta población de pacientes. Este grupo de fármacos ha documentado adecuada eficacia clínica y seguridad en estos pacientes. Se espera que la incorporación de nuevas equinocandinas al mercado aminore sus costos y mejore el acceso a este grupo de fármacos.
Invasive infections by Candida strains are a relevant pathology in critically ill patients. Candida should be considered where a high risk of infection is present for a critical early diagnosis. Despite the incorporation of new drugs in the therapeutic armamentarium over the last decade, mortality remains high. The key in improving clinical outcomes of these patients are the use of early effective therapies that offer coverage against different strains of Candida: C. albicans and non-albicans. Recent international guidelines suggest empiric therapy with echinocandins in suspected invasive candidiasis in this patient population. This group of drugs adequately documented clinical efficacy and safe use in these patients. The emergence of new echinocandins could improve access to these drugs by reducing their cost.