Perfil clínico-epidemiológico de infecções invasivas pelo complexo Candida parapsilosis em um hospital pediátrico terciário: um estudo transversal

Abstract

Candida species are associated with several clinical manifestations, being listed as the main fungal infections in tertiary hospitals. The genus comprises approximately 300 species, some of which are potentially pathogenic for humans, such as the Candida parapsilosis complex, formed by C. parapsilosis sensu stricto, C. orthopsilosis and C. metapsilosis, indistinguishable for clinical microbiology laboratories. The present study aimed to describe the clinical, epidemiological and laboratory characteristics of deep infections caused by the C. parapsilosis complex that occurred in a Brazilian tertiary pediatric hospital during the COVID-19 pandemic. Clinical samples were processed by the BACT/ALERT® 3D system or directly onto agar plates. Definitive identification was obtained by MALDI-TOF MS. Susceptibility to antifungals was performed using the VITEK 2 AST-YS08 card and confirmed using the CLSI protocol. Patient data were collected from medical records using a structured questionnaire. Species of the C. parapsilosis complex were isolated from 124 patients over a period of 18 months, namely: C. parapsilosis sensu stricto (83.87%), C. orthopsilosis (13.71%) and C. metapsilosis (2.42%). No antifungal resistance was detected. Patients aged <1 to 18 years and most from sectors related to oncology, being more affected by C. parapsilosis sensu stricto (p=0.012). C. orthopsilosis infections were significantly more frequent (p=0.012) in intensive care unit patients. Invasive infections caused by different pathogens occurred in 75 patients up to 30 days after isolation of C. parapsilosis complex strains. Overall, 23 (18.55%) patients died within 30 days of the C. parapsilosis complex culture incident. Catheter removal and antifungal therapy were important measures to prevent mortality. Co-infection with COVID-19 was detected in only one patient.