Frequência e sensibilidade antifúngica de candida spp. isoladas de úlceras de pé diabético

Abstract

Patients with diabetes represent a unique group of individuals who appear to be more likely to develop infections than others. Foot problems represent one of the most important chronic complications of diabetes mellitus. The risk of lower limb amputation can be increased if ulceration is followed by bacterial, fungal, and, in more severe cases, synergism between bacterial and fungal infections. However, there is a lack of reports in the literature of the incidence of fungal pathogens in these samples. This study aims to describe, through a prospective study, the culture, isolation, identification and sensitivity test of Candida spp. present in diabetic patient´s foot ulcers. Samples were collected at the North Regional Hospital from September 2015 to September 2016. A total of 154 samples were collected from 77 patients, where 50.65 % were female and 49.35 % were male. Of the total number of patients, 59.74 % were diagnosed with type 2 diabetes mellitus, where hypertension was the most prevalent comorbidity. Patients aged 71-80 years were more susceptible to complications of diabetes and the majority of patients (70.13 %) had fasting glycemia values above the reference value. Peripheral vascular disease was present in all patients, where 97.40 % had necrotic and infected lesions in the feet, increasing cases of debridement and revascularization. Of the total number of pacientes, 70.13 % had local or generalized amputation, being classified in grade 4 or 5, by Wagner's Classification, where, consequently, all of them were in antibacterial use, but none were using antifungal. In total, 59.74 % and 54.54 % of the patients never received care orientation or did daily selfexamination of the feet, respectively; and 97.40 % had their wounds reinfected, being necessary to perform new vascular procedures. The fungal species that grew in culture were identified through the conventional mycological methodology. Most of the samples identified were C. tropicalis (44.33 %) and all samples of C. albicans identified and isolated in the study were tested for antifungal sensitivity. Species of Candida nonalbicans are being more incident than the species of C. albicans. All C. albicans samples from this study were considered sensitive to the sensitivity test, according to the methodology and references of CLSI-M27A2. The number of deaths of patients related to diabetic foot in this study was worrisome (14.29 %). Preventive and primary measures should be taken to decrease the high mortality rate in diabetic patients with foot ulcers. Self-care is an important factor in the prevention of complications in diabetic feet and, for good disease control, effective self-management is necessary. We believe that our results have important implications for the prevention and recognition of fungal infections in diabetic foot and we recommend that diabetic patients with foot problems should be routinely examined for mycological evaluation because fungi play a potential role in the pathogenesis of ulceration.