Aspectos epidemiológicos e de susceptibilidade aos antifúngicos de leveduras isoladas em pacientes hospitalizados sem e com COVID-19

Abstract

Invasive fungal infections have increased notably in recent decades, especially those associated with Intensive Care Units and immunocompromised patients, including, recently, the participation of these microorganisms in coinfections in patients hospitalized for COVID-19. Given the relevance of these fungi infections, the precariousness of routine laboratory diagnosis and, as a consequence, the empirical antimicrobial prescription, epidemiological and antifungal susceptibility studies are extremely important to guide clinical management and prognosis. The study objective was to evaluate the epidemiological profile of hospitalized participants with yeast laboratory found and the susceptibility to drugs of yeast isolates from blood cultures between 2015-2018 and co-infections in hospitalized participants with COVID-19 in the period from 2019 to 2021. The evaluated yeasts were isolated from blood culture, secretion tracheal and urine, in accordance with ethical aspects for research involving human beings. Patient data were collected from electronic medical records. Yeast identification was performed by MALDI-TOF MS. Antifungal susceptibility was determined by disk diffusion for fluconazole, itraconazole, voriconazole, amphotericin B and caspofungin. Statistical analysis (ANOVA and Bonferroni, chi-square and kappa coefficient) was performed using the GraphPad Prism 5.01® software. Between 2015-2018, 84 yeast samples were isolated from blood cultures of 42 patients; between 2019-2021, 51 samples were isolated from 44 patients. The most prevalent species were C. albicans, C. tropicalis and C. glabrata; and more frequent in adults and ICU patients for both groups, with hospitalization for more than 27 days. The resistance phenotype was higher in the azole class and isolates from patients without COVID-19. 50.4% were resistant to at least one of the tested drugs and 30% were resistant to at least three of the five antifungals tested. The importance of studies that evaluate the resistance to antifungals of clinical samples is highlighted, as well as the characterization of the species by molecular methods.