Candidemia: avaliação dos fatores associados e da sensibilidade ao fluconazol
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Data
2010-10-03
Autores
Mondelli, Alessandro Lia [UNESP]
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Editor
Universidade Estadual Paulista (Unesp)
Resumo
As leveduras vêm se tornando um dos principais agentes etiológicos das infecções hospitalares encontrados em pacientes com imunossupressão, muitas vezes evoluindo para quadros de sepse fúngica, na qual a mortalidade é elevada. Vários fatores associados diferentes, para o desenvolvimento de candidemia, têm sido estudados. Porém, tem-se dificuldade para escolher o tratamento desses quadros sépticos, uma vez que os métodos utilizados atualmente para verificar sensibilidade necessitam de técnicas trabalhosas e com resultados demorados para uso em laboratórios de rotina médica. Os objetivos do presente trabalho foram: estudar os fatores associados para o desenvolvimento de candidemia, bem como, comparar a eficácia do antifungigrama, realizado por método de disco difusão em ágar 24 e 48 horas e pelo método do Etest®, para o fluconazol, com a metodologia da microdiluição; além de avaliar a viabilidade da identificação das espécies de Candida por metodologia automatizada, dos sistemas Vitek-Biomerieux (Durham NC, USA) e manual, chamada de mista (tubo germinativo e Chromagar Candida (Difco, Sparks, MD-EUA), com a metodologia tradicional de referência. Analisaram-se 98 prontuários retrospectivamente do período compreendido entre os anos de 2000 a 2006, que possuíam amostras viáveis de Candida spp para o estudo. Os fatores associados mais prevalentes para o desenvolvimento de candidemia no total geral dos pacientes foram: o uso de antimicrobianos e antifúngicos com 93,9% e 79,6% respectivamente; a utilização do cateter venoso central com 93,9%; a presença de ventilação mecânica com 73,5% além da nutrição parenteral com 60,2% dos casos. As principais espécies de Candida encontradas foram C. parapsilosis com 37,76% e C. albicans com 33,67%; Candida não-albicans somaram 66,33% dos casos. A C. glabrata apresentou o maior índice de mortalidade do estudo, com 75% dos...
Yeasts are becoming some of the most common causes of nosocomial fungal infections that can be found in immunocompromised patients. Such infections many times develop to sepsis, whose mortality rate is high. Many different associated factors for the development of candidemia have been studied, but there is a great difficulty to choose the treatment of such cases because of the current methods of susceptibility testing, which are usually refined and time-consuming techniques for routine use in laboratory medicine. The aim of this study was to evaluate the factors associated with the development of candidemia, and fluconazole efficacy in disk diffusion test and Etest® as well as evaluate the viability of identification of Candida species by automated system Vitek-Biomerieux (Durham NC, USA), manual method (germinative tube) and Chromagar Candida (Difco, Sparks, MD-EUA). Ninety eight medical charts of patients with Candida spp samples available for the study were retrospectively analyzed. The results showed that the most prevalent risk factors to develop candidemia were: antibiotics and antifungal agents (93.9% and 79.6%, respectively); use of venal central catheter (93.9%); the presence of mechanical ventilation (73.5%) and parenteral nutrition (60.2%). The main species of Candida found were C. parapsilosis (37.76%), C. albicans (33.67%) and Candida non albicans (66.33%). C. glabrata showed the best mortality rate (75%), followed by C. tropicalis (57.1%) and C.albicans (54.5%). The disk diffusion test with visual reading and Cecom disk (São Paulo, Brazil) after 24 hours was recommended for utilization in laboratory routine with 81.6% agreement with the reference method. The disk diffusion test with visual reading and Cecom disk after 48 hours was not recommended for utilization in laboratory routine with only 72.4% of agreement with the reference method... (Complete abstract click electronic access below)
Yeasts are becoming some of the most common causes of nosocomial fungal infections that can be found in immunocompromised patients. Such infections many times develop to sepsis, whose mortality rate is high. Many different associated factors for the development of candidemia have been studied, but there is a great difficulty to choose the treatment of such cases because of the current methods of susceptibility testing, which are usually refined and time-consuming techniques for routine use in laboratory medicine. The aim of this study was to evaluate the factors associated with the development of candidemia, and fluconazole efficacy in disk diffusion test and Etest® as well as evaluate the viability of identification of Candida species by automated system Vitek-Biomerieux (Durham NC, USA), manual method (germinative tube) and Chromagar Candida (Difco, Sparks, MD-EUA). Ninety eight medical charts of patients with Candida spp samples available for the study were retrospectively analyzed. The results showed that the most prevalent risk factors to develop candidemia were: antibiotics and antifungal agents (93.9% and 79.6%, respectively); use of venal central catheter (93.9%); the presence of mechanical ventilation (73.5%) and parenteral nutrition (60.2%). The main species of Candida found were C. parapsilosis (37.76%), C. albicans (33.67%) and Candida non albicans (66.33%). C. glabrata showed the best mortality rate (75%), followed by C. tropicalis (57.1%) and C.albicans (54.5%). The disk diffusion test with visual reading and Cecom disk (São Paulo, Brazil) after 24 hours was recommended for utilization in laboratory routine with 81.6% agreement with the reference method. The disk diffusion test with visual reading and Cecom disk after 48 hours was not recommended for utilization in laboratory routine with only 72.4% of agreement with the reference method... (Complete abstract click electronic access below)
Descrição
Palavras-chave
Candidiase, Antifungal susceptibility
Como citar
MONDELLI, Alessandro Lia. Candidemia: avaliação dos fatores associados e da sensibilidade ao fluconazol. 2010. 105 f. Tese (doutorado) - Universidade Estadual Paulista, Faculdade de Medicina de Botucatu, 2010.