Análise diferencial da capacidade de formação de biofilmes e sensibilidade antifúngica de Candida albicans e espécies não-albicans de Candida isoladas de pacientes criticamente enfermos sujeitos a eventos adversos relacionados à assistência

Abstract

Objective. This study aims the differential analysis of biofilm formation capability and antifungal susceptibility of planktonic cells and Candida albicans biofilms and nonalbicans Candida spp. isolated from critically ill patients subject to care-related adverse events. Methodology. Samples of Candida spp. isolated from tracheal secretions, urine, bloodstream, and other sites from patients, over 18 years of age, from the Intensive Care and Emergency sectors of the Irmandade do Hospital Santa Casa de Poços de Caldas, who are subjected to incidents that may be related to the establishment of fungal infection. The isolates were identified by MALDI-TOF mass spectrometry and evaluated for the susceptibilityof planktonic cells and biofilms to the antifungal agent’s amphotericin B, fluconazole and itraconazole. The medical records of these patients were examined from the date of the 1st hospitalization until the moment of clinical outcome, with discharge or death of the patient. The identity of the patients and the information contained in the medical records were preserved in accordance with CNS Resolution No. 466/2012. The screening criteria adopted for the analysis of medical records made reference to health care, intensive care and medication prescription. Results. The medical records and samples from 43 patients were analyzed. The length of hospital stay ranged from 1 to 127 days and all patients underwent, during the period of their hospitalization, one or more adverse events related to care, such as the use of mechanical ventilation, central venous catheter peripheral venous catheter (PVC), indwelling urinary catheter (SVD), use of vasoactive substances, among others. The 43 patients were positive for fungal culture, which is one of the main criteria for patient selection in this research. From the 43 samples, 23 were identified phenotypically as belonging to the species C. albicans and 20 as Candida ssp. non-albicans species from the genus. From this total, 33 could be identified by MALDI-TOF (51.5% C. albicans and 48.5% non albicans Candida spp) and showed the ability to form biofilms, with 30% of the isolates showing biofilms with high metabolic potential. Related to antifungal susceptibility, a direct relationship was observed with susceptibility to Amphotericin B and situations of low susceptibility to Itraconazole and Fluconazole drugs, including situations of resistance. Conclusion. The relevance of this research is solidly based on the increasing need for health centers, such as hospitals, which deal with critically ill patients, knowning their fungal community and their antifungal susceptibility profiles; as well as the percentage of biofilm formation that can negatively influence the ability to resolve infectious processes, the action of the antifungal agents then used and their correlation with the eventual and inevitable adverse event related to care.