RESUMO
The capacity of Candida spp. to form biofilms allows them to attach either to living or inert surfaces, promoting their persistence in hospital environments. In a previous study, we reported strain-to-strain variations in Candida spp. biofilm development, suggesting that some genotypes may be greater biofilm formers than others. In this study, we hypothesize that isolates pertaining to clusters may be found more frequently in the environment due to their ability to form biofilms compared to singleton genotypes. Two hundred and thirty-nine Candida spp. isolates (78 clusters) from candidemia patients admitted to 16 hospitals located in different cities and countries-and the same number of singleton genotypes used as controls-were tested in terms of biofilm formation using the crystal violet and the XTT reduction assays. Candida albicans clusters showed higher biofilm formation in comparison to singleton genotypes (P < .01). The biofilms formed by intra-hospital C. albicans clusters showed higher metabolic activity (P < .05). Furthermore, marked variability was found among species and type of cluster. We observed that the higher the number of isolates, the higher the variability of biofilm production by isolates within the cluster, suggesting that the production of biofilm by isolates of the same genotype is quite diverse and does not depend on the type of cluster studied. In conclusion, candidemia Candida spp. clusters-particularly in the case of C. albicans-show significantly more biomass production and metabolic activity than singleton genotypes.
Assuntos
Biofilmes/crescimento & desenvolvimento , Candida albicans/crescimento & desenvolvimento , Candida albicans/genética , Candida parapsilosis/crescimento & desenvolvimento , Candida parapsilosis/genética , Candida tropicalis/crescimento & desenvolvimento , Candida tropicalis/genética , Brasil , Dinamarca , Variação Genética , Genótipo , Humanos , Itália , EspanhaAssuntos
Valva Aórtica/microbiologia , Candida parapsilosis , Candidíase , Próteses e Implantes/microbiologia , Antifúngicos/uso terapêutico , Valva Aórtica/cirurgia , Candida parapsilosis/efeitos dos fármacos , Candida parapsilosis/crescimento & desenvolvimento , Candidíase/tratamento farmacológico , Candidíase/microbiologia , Candidíase/patologia , Endocardite/complicações , Endocardite/tratamento farmacológico , Endocardite/microbiologia , Feminino , Humanos , Pessoa de Meia-IdadeRESUMO
Candidemia has been considered a persistent public health problem with great impact on hospital costs and high mortality. We aimed to evaluate the epidemiology and prognostic factors of candidemia in a tertiary hospital in Northeast Brazil from January 2011 to December 2016. Demographic and clinical data of patients were retrospectively obtained from medical records and antifungal susceptibility profiling was performed using the broth microdilution method. A total of 68 episodes of candidemia were evaluated. We found an average incidence of 2.23 episodes /1000 admissions and a 30-day mortality rate of 55.9%. The most prevalent species were Candida albicans (35.3%), Candida tropicalis (27.4%), Candida parapsilosis (21.6%) and Candida glabrata (11.8%). Higher mortality rates were observed in cases of candidemia due to C. albicans (61.1%) and C. glabrata (100%), especially when compared to C. parapsilosis (27.3%). Univariate analysis revealed some variables which significantly increased the probability of death: older age (P = 0.022; odds ratio [OR] = 1.041), severe sepsis (P < 0.001; OR = 8.571), septic shock (P = 0.035; OR = 3.792), hypotension (P = 0.003; OR = 9.120), neutrophilia (P = 0.046; OR = 3.080), thrombocytopenia (P = 0.002; OR = 6.800), mechanical ventilation (P = 0.009; OR = 8.167) and greater number of surgeries (P = 0.037; OR = 1.920). Multivariate analysis showed that older age (P = 0.040; OR = 1.055), severe sepsis (P = 0.009; OR = 9.872) and hypotension (P = 0.031; OR = 21.042) were independently associated with worse prognosis. There was no resistance to amphotericin B, micafungin or itraconazole and a low rate of resistance to fluconazole (5.1%). However, 20.5% of the Candida isolates were susceptible dose-dependent (SDD) to fluconazole and 7.7% to itraconazole. In conclusion, our results could assist in the adoption of strategies to stratify patients at higher risk for developing candidemia and worse prognosis, in addition to improve antifungal management.
Assuntos
Candidemia/diagnóstico , Candidemia/epidemiologia , Infecção Hospitalar/diagnóstico , Infecção Hospitalar/epidemiologia , Choque Séptico/diagnóstico , Choque Séptico/epidemiologia , Adulto , Fatores Etários , Idoso , Análise de Variância , Antifúngicos/uso terapêutico , Brasil/epidemiologia , Candida albicans/efeitos dos fármacos , Candida albicans/crescimento & desenvolvimento , Candida albicans/patogenicidade , Candida glabrata/efeitos dos fármacos , Candida glabrata/crescimento & desenvolvimento , Candida glabrata/patogenicidade , Candida parapsilosis/efeitos dos fármacos , Candida parapsilosis/crescimento & desenvolvimento , Candida parapsilosis/patogenicidade , Candida tropicalis/efeitos dos fármacos , Candida tropicalis/crescimento & desenvolvimento , Candida tropicalis/patogenicidade , Candidemia/tratamento farmacológico , Candidemia/mortalidade , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/mortalidade , Farmacorresistência Fúngica , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Incidência , Masculino , Pessoa de Meia-Idade , Prognóstico , Respiração Artificial/efeitos adversos , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Choque Séptico/tratamento farmacológico , Choque Séptico/mortalidade , Análise de Sobrevida , Centros de Atenção Terciária , Trombocitopenia/diagnóstico , Trombocitopenia/fisiopatologiaRESUMO
Candida parapsilosis sensu stricto (C. parapsilosis) has emerged as the second/third commonest Candida species isolated from hospitals worldwide. Candida spp. possess numerous virulence attributes, including peptidases that play multiple roles in both physiological and pathological events. So, fungal peptidases are valid targets for new drugs development. With this premise in mind, we have evaluated the effect of serine peptidase inhibitors (SPIs) on both cell biology and virulence aspects of C. parapsilosis. First, five different SPIs, phenylmethylsulfonyl fluoride, benzamidine, 4-(2-aminoethyl) benzenesulfonyl fluoride hydrochloride, N-α-tosyl-L-lysine chloromethyl ketone hydrochloride, and N-tosyl-L-phenylalanine chloromethyl ketone (TPCK) were tested, and TPCK showed the best efficacy to arrest fungal growth. Subsequently, the ability of TPCK to modulate physiopathological processes was investigated. Overall, TPCK was able to (i) inhibit the cell-associated serine peptidase activities, (ii) promote morphometric and ultrastructural alterations, (iii) induce an increase in the intracellular oxidation level, which culminates in a vigorous lipid peroxidation and accumulation of neutral lipids in cytoplasmic inclusions, (iv) modulate the expression/exposition of surface structures, such as mannose/glucose-rich glycoconjugates, N-acetylglucosamine-containing molecules, chitin, polypeptides and surface aspartic peptidases, (v) reduce the adhesion to either polystyrene or glass surfaces as well as to partially disarticulate the mature biofilm, (vi) block the fungal interaction with macrophages, and (vii) protect Galleria mellonella from fungal infection, enhancing larvae survivability. Altogether, these results demonstrated that TPCK induced several changes over fungal biology besides the interference with aspects associated to C. parapsilosis virulence and pathogenesis, which indicates that SPIs could be novel promising therapeutic agents in dealing with candidiasis.
Assuntos
Antifúngicos/farmacologia , Candida parapsilosis/efeitos dos fármacos , Candidíase/prevenção & controle , Inibidores de Serina Proteinase/farmacologia , Tosilfenilalanil Clorometil Cetona/farmacologia , Animais , Antifúngicos/administração & dosagem , Candida parapsilosis/citologia , Candida parapsilosis/crescimento & desenvolvimento , Adesão Celular/efeitos dos fármacos , Modelos Animais de Doenças , Larva/microbiologia , Lepidópteros/microbiologia , Estresse Oxidativo , Inibidores de Serina Proteinase/administração & dosagem , Análise de Sobrevida , Tosilfenilalanil Clorometil Cetona/administração & dosagem , Resultado do Tratamento , Virulência/efeitos dos fármacosRESUMO
In this study, phenotypic methods presented >80% agreement with the molecular identification of 59 Candida parapsilosis complex. Growth at 15% NaCl or pH 7.0 significantly reduced cfu-counts of Candida orthopsilosis, suggesting these conditions may support the development of phenotypic methods for the differentiation of the cryptic species of C. parapsilosis complex.
Assuntos
Candida parapsilosis/isolamento & purificação , Candidíase/microbiologia , Técnicas de Tipagem Micológica/métodos , Candida parapsilosis/classificação , Candida parapsilosis/genética , Candida parapsilosis/crescimento & desenvolvimento , Meios de Cultura/metabolismo , Humanos , Fenótipo , Reação em Cadeia da PolimeraseRESUMO
In recent decades, the prognosis for burn patients has improved considerably with the development of specialized care. The acellular dermal matrix (ADM) is a totally artificial acellular device that functions to control water loss, prevent penetration by bacteria and allow migration of endothelial cells and fibroblasts from patient tissues. However, little is known about its effectiveness against yeasts. The present study evaluated the capacity of colonization and migration of some human commensal yeasts. Three clinical isolates from skin scales, identified as Candida parapsilosis, Candida glabrata and Rhodotorula mucilaginosa, were used. Their ability to cross the ADM was evaluated. After three days, all isolates had crossed the ADM. C. parapsilosis showed the lowest growth, while R. mucilaginosa showed intermediate and C. glabrata the highest growth. In the plates incubated for seven days, the growth of C. parapsilosis and C. glabrata increased by 1 log over the third day. All isolates have the capacity to colonize and migrate through the matrix, increasing the potential risk to burn patients, who can develop severe and even fatal infections by invasive fungi.
Assuntos
Derme Acelular/microbiologia , Queimaduras/complicações , Queimaduras/microbiologia , Leveduras/crescimento & desenvolvimento , Queimaduras/patologia , Candida glabrata/crescimento & desenvolvimento , Candida glabrata/patogenicidade , Candida parapsilosis/crescimento & desenvolvimento , Candida parapsilosis/patogenicidade , Interações Hospedeiro-Patógeno , Humanos , Rhodotorula/crescimento & desenvolvimento , Rhodotorula/patogenicidade , Fatores de Risco , Pele/lesões , Pele/microbiologia , Pele/patologia , Leveduras/isolamento & purificação , Leveduras/patogenicidadeRESUMO
AIM: The aim of the present study was to compare different disinfection techniques for the peritoneal dialysis bag medication port (MP). METHODS: An experimental study was conducted testing different cleaning agents (70% alcohol vs 2% chlorhexidine) and time periods (5, 10 and 60 s) for disinfection of the MP. Five microorganisms (S. aureus, E. coli, A. baumannii and C. parapsilosis, CNS) were prepared for use as contaminants of the MP. MP were incubated in Tryptic soy broth at 36°C for 24 h, after which, they were seeded on a Biomérieux blood agar plate and incubated for 24 h at 36°C. RESULTS: Three hundred peritoneal dialysis bags were analyzed regarding the time expose to the disinfectant showed a statistically significant difference in the number of culture positive (7/100) P = 0.001; Gram positive (6/100) P = 0.006 for 5 s, one positive culture and turbid bag with 10 s, while friction for 60 s showed all negative results. The comparison between disinfectant, alcohol or chlorhexidine, 150 bag in each group, showed that the ones disinfected with alcohol had five turbid bags, eight positive cultures and seven germs identified, while all bags disinfected with chlorhexidine were negative for all parameters, with a difference statistically significant (P = 0.004). CONCLUSION: Our results suggest that the MP should be scrubbed with 2% chlorhexidine for at least 5 s; if alcohol 70% is used the length of friction should not be inferior to 10 s.
Assuntos
Bactérias/efeitos dos fármacos , Candida parapsilosis/efeitos dos fármacos , Clorexidina/farmacologia , Descontaminação/métodos , Desinfetantes/farmacologia , Desinfecção/métodos , Contaminação de Equipamentos/prevenção & controle , Etanol/farmacologia , Diálise Peritoneal/instrumentação , Bactérias/crescimento & desenvolvimento , Candida parapsilosis/crescimento & desenvolvimento , Fricção , Diálise Peritoneal/efeitos adversos , Fatores de TempoRESUMO
Abstract In this study, phenotypic methods presented >80% agreement with the molecular identification of 59 Candida parapsilosis complex. Growth at 15% NaCl or pH 7.0 significantly reduced cfu-counts of Candida orthopsilosis, suggesting these conditions may support the development of phenotypic methods for the differentiation of the cryptic species of C. parapsilosis complex.