Uma análise epidemiológica das infecções urinárias por Candida spp. em unidade de terapia intensiva
DOI:
https://doi.org/10.17058/reci.v12i2.17026Resumo
O achado de espécies de Candida na urina é um achado comum e é chamado de candidúria. Há um aumento na frequência de infecções do trato urinário (ITU) causadas por Candida, principalmente em pacientes críticos. Este estudo teve como objetivo determinar as características epidemiológicas, clínicas e micológicas das infecções urinárias por Candida em unidade de terapia intensiva (UTI) e a susceptibilidade aos antifúngicos. Métodos: Foram avaliadas culturas de urina de 394 pacientes de UTI com suspeita clínica de ITU. Após 24-48 horas de incubação, as colônias pareceram crescer como leveduras, foram morfologicamente examinadas por coloração de Gram. As cepas de Candida que cresceram ≥104 UFC/mL em culturas de urina foram aceitas como candidúria. As suscetibilidades das cepas de Candida à anfotericina B, itraconazol, fluconazol, voriconazol, flucitosina e caspofungina foram investigadas com o método de microdiluição em caldo. Resultados: A distribuição das cepas 100 isoladas de Candida urinária foi de 54 Candida albicans, 34 C. glabrata, 7 C. tropicalis, 2 C. kefyr, 2 C. lusitaniae e 1 como C. parapsilosis. Entre 100 espécies de Candida isoladas em nosso estudo, as taxas de susceptibilidade de anfotericina B, flucitosina, caspofungina, fluconazol, itraconazol e voriconazol foram de 100%, 100%, 91%, 23%, 13%, 25,8%, respectivamente. Conclusão: A identificação precisa de Candida spp., bem como a investigação da susceptibilidade aos antifúngicos, será benéfica em termos de eficácia do tratamento e prevenção do desenvolvimento de resistência.
Downloads
Referências
Gajdács M, Dóczi I, Ábrók M, et al. Epidemiology of candiduria and Candida urinary tract infections in inpatients and outpatients: results from a 10-year retrospective survey. Cent European J Urol. 2019;72(2):209-214. https://doi.org/10.5173/ceju.2019.1909
Hollenbach E. To treat or not to treat--critically ill patients with candiduria. Mycoses. 2008;51(2):12-24. https://doi.org/10.1111/j.1439-0507.2008.01570.x
Kauffman CA, Vazquez JA, Sobel JD, et al. Prospective multicenter surveillance study of funguria in hospitalized patients. The National Institute for Allergy and Infectious Diseases (NIAID) Mycoses Study Group. Clin Infect Dis. 2000;30(1):14-18. https://doi.org/10.1086/313583
Bougnoux ME, Kac G, Aegerter P, et al. Candidemia and candiduria in critically ill patients admitted to intensive care units in France: incidence, molecular diversity, management and outcome. Intensive Care Med. 2008;34(2):292-299. https://doi.org/10.1007/s00134-007-0865-y
Fisher JF, Sobel JD, Kauffman CA, et al. Candida urinary tract infections--treatment. Clin Infect Dis. 2011;52(Suppl 6):457-66. https://doi.org/10.1093/cid/cir112
Fisher JF. Candida urinary tract infections--epidemiology, pathogenesis, diagnosis, and treatment: executive summary. Clin Infect Dis. 2011;52(Suppl 6):429-32. https://doi.org/10.1093/cid/cir108
Kauffman CA. Candiduria. Clin Infect Dis. 2005;41:371–6. https://doi.org/10.1086/430918
Alvarez-Lerma F, Nolla-Salas J, León C, et al. Candiduria in critically ill patients admitted to intensive care medical units. Intensive Care Med. 2003;29(7):1069-1076. https://doi.org/10.1007/s00134-003-1807-y
Sobel JD, Fisher JF, Kauffman CA, et al. Candida urinary tract infections--epidemiology. Clin Infect Dis. 2011;52(Suppl 6):433-6. https://doi.org/10.1093/cid/cir109
Alfouzan WA. Epidemiological study on species identification and susceptibility profile of Candida in urine. Fungal Genom Biol. 2015;5:124. https://doi.org/10.4172/2165-8056.1000124
Achkar JM, Fries BC. Candida infections of the genitourinary tract. Clin Microbiol Rev. 2010;23(2):253-273. https://doi.org/10.1128/CMR.00076-09
Jamil S, Jamil N, Saad U, et al. Frequency of Candida albicans in Patients with Funguria. J Coll Physicians Surg Pak. 2016;26(2):113-116.
Sakamoto Y, Kawabe K, Suzuki T, et al. Species Distribution of Candidemia and Their Susceptibility in a Single Japanese University Hospital: Prior Micafungin Use Affects the Appearance of Candida parapsilosis and Elevation of Micafungin MICs in Non-parapsilosis Candida Species. J Fungi (Basel). 2021;7(8):596. https://doi.org/10.3390/jof7080596
He Z, Huo X, Lei D, et al. Management of candiduria in hospitalized patients: a single-center study on the implementation of IDSA guidelines and factors affecting clinical decisions. Eur J Clin Microbiol Infect Dis. 2021;40(1):59-65. https://doi.org/10.1007/s10096-020-03999-1
Denis B, Chopin D, Piron P, et al. Candiduria in kidney transplant recipients: Is antifungal therapy useful?. Mycoses. 2018;61(5):298-304. https://doi.org/10.1111/myc.12740
Sobel JD, Kauffman CA, McKinsey D. Candiduria: a randomized, double-blind study of treatment with fluconazole and placebo. The National Institute of Allergy and Infectious Diseases (NIAID) Mycoses Study Group. Clin Infect Dis. 2000;30(1):19-24. https://doi.org/10.1086/313580
Clinical and Laboratory Standards Institute (CLSI). Reference method for broth dilution antifungal susceptibility testing of yeasts; approved Standard-third edition. CLSI document M27-A3. Clinical and Laboratory Standards Institute, Wayne, Pennsylvania 2008.
Clinical and Laboratory Standards Institute (CLSI). Reference method for broth dilution antifungal susceptibility testing of yeasts; third informational supplement CLSI document M27-S3. Clinical and Laboratory Standards Institute, Wayne, Pennsylvania 2008.
Clinical and Laboratory Standards Institute (CLSI). Reference method for broth dilution antifungal susceptibility testing of yeasts; fourth informational supplement CLSI document M27-S4. Clinical and Laboratory Standards Institute, Wayne, Pennsylvania 2012.
Wang K, Hsueh K, Kronen R, et al. Creation and assessment of a clinical predictive model for candidaemia in patients with candiduria. Mycoses. 2019;62(7):554-561. https://doi.org/10.1111/myc.12917
García-Agudo L, Rodríguez-Iglesias M, Carranza-González R. Approach of clinicians to candiduria and related outcome in the elderly. J Mycol Med. 2018;28(3):428-432. https://doi.org/10.1016/j.mycmed.2018.05.011
He Z, Su C, Bi Y, et al. Evaluation of a Novel Laboratory Candiduria Screening Protocol in the Intensive Care Unit. Infect Drug Resist. 2021;14:489-496. https://doi.org/10.2147/IDR.S289885
He Z, Liu Y, Wang T, et al. Candiduria in hospitalized patients: an investigation with the Sysmex UF-1000i urine analyzer. PeerJ. 2019;7:e6935. https://doi.org/10.7717/peerj.6935
Aghili SR, Abastabar M, Soleimani A, Haghani I, Azizi S. High prevalence of asymptomatic nosocomial candiduria due to Candida glabrata among hospitalized patients with heart failure: a matter of some concern?. Curr Med Mycol. 2020;6(4):1-8. https://doi.org/10.18502/cmm.6.4.5327
Downloads
Publicado
Como Citar
Edição
Seção
Licença
Copyright (c) 2022 Fahriye Ekşi, Ban Ali Hassan, Berna Kaya Uğur, Hamit Yıldız, Mehmet Erinmez, Süleyman Ganidağlı
Este trabalho está licenciado sob uma licença Creative Commons Attribution 4.0 International License.
The author must state that the paper is original (has not been published previously), not infringing any copyright or other ownership right involving third parties. Once the paper is submitted, the Journal reserves the right to make normative changes, such as spelling and grammar, in order to maintain the language standard, but respecting the author’s style. The published papers become ownership of RECI, considering that all the opinions expressed by the authors are their responsibility. Because we are an open access journal, we allow free use of articles in educational and scientific applications provided the source is cited under the Creative Commons CC-BY license.