Perfil de sensibilidade e genotipagem de leveduras isoladas de pacientes com candidemia em dois hospitais de referência terciária de Fortaleza-Ceará

Abstract

The systemic infections caused by yeasts of the genus Candida are considered opportunist mycoses of high risk in hospital environments. These infections represent important therapeutical challenge, by reason of arising of species resistent to some antifungals, associated with high rate of mortality. Therefore, this work sought: To verify the frequency of fungemias at Dr. César Cals Hospital and Albert Sabin Children Hospital; identify the etiological agents implicated; determine the sensitivety profile to antifulgal and evaluate the genotypical profile of the species isolated from patients with recurrency. For this, were recuperated from 4627 hemcultures, 55 yeast-positive hemocultures at HGCC and from 5316 hemocultures 87 yeast-positive hemocultures at HIAS. From them, 23 patients at HGCC and from 43 at HIAS that had clinical histories with complet data entered this study. The mycological diagnosis was performed through biochemical and morphological characteristics of the etiological isolated. The test of sensitivety to antifungal- amphotericin B, fluconazole, itraconazole and cetoconazole- utilized the microdilution method in broth, reported in the document M27-A2 of the NCCLS. The genotyping techniques were performed through PFGE (Pulsed Field Gel Electrophresis), RAPD (Randomly amplified polymorphic DNA analysis). Within the period from june of 2000, to june of 2002 at HGCC, were analysed 4627 hemocultures, being positives 1051, of which 55 (5,2%) were positive for yeast of the genus Candida. On the other hand, in the period from june of 2001 to july of 2002 at HIAS, were analysed 5316 hemocultures, of which 87 (5,72%) were yeast-positive of the genus Candida and Rhodotorula.The main specie involved in the genus Candida, was C. parapsilosis with 36% and 42% of the cases at HGCC and HIAS respectively. The main risk factors associated with candidemia, were: the previous antibiotic therapy, central venous catheter, parenteral nutrition, gastric probe, mechanical ventilation, surgery and prematurity. About the resistance to antifungals drugs was observed that amphotericin B showed a resistance level of 4%, fluconazole-56%, itraconazole-52% and cetoconazole- 86%. The PFGE technique caracterized a cromossomic profile of 6 bands for C. parapsilosis and 4 for C. tropicalis. This technique permited the diferentiation of one cepa with changed pattern of bands for the last episode of the patient 4. The technique of RAPD chacacterized a distribution pattern of predominant bands for C. parapsilosis and was capable of characterize 4 genetical profiles, denoting reinfection in 3 patients and 2 genomic profiles were found for C. tropicalis. This assay shows the emergency of the non- albicans Candida, specially the C. parapsilosis, as main responsible for the cases of candidemia in the two hospitals of tertiary indication of Fortaleza, associated with a high resistance in vitro to antifungals. The genetical variability found in C. parapsilosis and C. tropicalis through the PFGE and RAPD techniques, revealed reinfection pictures, which rises the possibility that these be due to a contamination among patients or indirectly through the healthy workers.