Epidemiologia das candidúrias e perfil de susceptibilidade a agentes antifúngicos de amostras isoladas nos últimos anos em um Hospital Universitário de Minas Gerais

Abstract

The isolation of Candida species in urine samples (candiduria) has increased significantly in recent decades, associated with genitourinary system infection and candidemia, especially in individuals with risk factors for these conditions. Therefore, the aim of this study was to retrospectively evaluate the epidemiological and susceptibility profile of commercially available antifungal agents and also of new natural products, in samples isolated from patients hospitalized with candiduria at a University Hospital in the Zona da Mata Mineira. A total of 107 yeasts were isolated from urine of 75 patients, from March 2021 to January 2023. Most individuals were elderly ones (67%), females (75%), hospitalized for long periods in the Intensive Care Unit (44.9%) and using an indwelling urinary catheter (90.6%). The mortality rate of the evaluated individuals was 38.7%. Fungal identification was performed by phenotypic methods and MALDI-TOF MS, showing a good rate of matching between the manual methods and the molecular one. The most isolated species were C. albicans, C. glabrata, C. tropicalis and C. parapsilosis. Antifungal susceptibility testing was determined by disk diffusion method and the antifungals related to the highest resistance rates were fluconazole, voriconazole, itraconazole and caspofungin; and the yeast that presented the uppermost resistance profile was C. glabrata. The main antifungal agent used in the therapeutic management of the individuals evaluated in this study was fluconazole, which was associated with a mortality rate of 4% when administered for the treatment of infections caused by resistant strains. The antifungal activity of different extracts was investigated for the plants Amaranthus viridis, Stachys lanata, Glycyrrhiza inflata, Pothomorphe umbellata and Renealmia petasites, performed by using the broth microdilution assay. Only the extract of P. umbellata showed moderate inhibitory and fungicidal activity against some strains of Candida sp. As a result, we highlight the importance of studies that characterize the species and evaluate the frequency of antifungal resistance in yeasts isolated from clinical samples, as well as the search for new products with antifungal activity.