Análise da prevalência e perfil de suscetibilidade das espécies de Candida isoladas de hemoculturas em 2006 no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo / Pevalence and suscetibility profile of Candida species isolated from blood culture in 2006 at Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

AUTOR(ES)
DATA DE PUBLICAÇÃO

2009

RESUMO

INTRODUCTION: Although the spectrum of fungi causing bloodstream infections continues to expand, Candida species remain responsible for the majority of cases, causing significant morbidity and mortality. The introduction of new antifungal agents in the clinical practice has increased the need for new studies for monitoring changes in the epidemiology and susceptibility profiles of candidemia at a local and global level. PURPOSE: To determine the prevalence and incidence of candidemia, species distribution and antifungal susceptibility patterns at large Brazilian tertiary public hospital during 2006. METHODS: Data were collected retrospectively. Patients were evaluated for selected variables. The minimal inhibitory concentrations (MIC) were determined using Sensititre YeastOne Ò, considered the reference method, and Etest Ò. The following drugs were tested: amphotericin B (AMB); caspofungin (CAS); and posaconazole (POS),fluconazole (FLU) and voriconazole (VOR). The disk diffusion method was also employed for FLU and VOR. MIC results obtained by Etest Ò, Sensititre YeastOne Ò and disk diffusion were compared. RESULTS: The prevalence of Candida spp. from blood cultures was 3,5%. One hundred and thirty-six cases of candidemia were identified. The overall incidence of candidemia was 1,87 cases per 1.000 admissions and 0,27 cases per 1.000 patient-days. 58.1% patients were male and the median age was 40 years. Cancer was the most frequent underlying disease. C. albicans was the most commonly identified species (52,2%), followed by C. parapsilosis (22,1%), C. tropicalis (14,8%) and C. glabrata (6,6%). The susceptibility profile of 100 Candida spp. isolates was: 100% to AMB B and CAS; 98 % to voriconazole; 91% to fluconazole; and 66% itraconazole. For posaconazole MIC90 was 0,25 µg/mL. The percentage of essential agreement (EA) and categorical agreement (CA) between the reference and test methods was >93%, except for itraconazole (EA 80%, CA 70%). The (CA) between Sensititre YeastOne Ò versus disk diffusion and Etest Ò versus disk diffusion were respectively: FLU (94%) (95%) and VOR (96%) (98%). Minor errors accounted for the majority of all categorical errors. CONCLUSION: The prevalence and incidence of candidemia found in this study were in agreement with previous national reports. There was a good in vitro activity for most drugs tested against Candida spp. except for itraconazole. A good EA was demonstrated between methods except again for itraconazole. Minor errors accounted for the majority of all categorical errors for between methods.

ASSUNTO(S)

antibióticos epidemiology epidemiologia microbial sensitivity tests triazoles candida amphotericin b triazóis fungemia candida anfotericina b antifungal agents fungemia testes de sensibilidade microbiana

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