Phenotypic and genotypic profile of Candida spp. strains in candidemia episodes of Hospital das Clínicas of Faculdade de Medicina de Ribeirão Preto - FMRP-USP

Candida spp. are responsible for 80% of all systemic fungal infections. In the Intensive Care Units, these yeasts are present in 17% of all infections. These diseases result in extended hospitalization, leading to increased hospital costs; besides, the systemic infections caused by Candida spp. are related to high mortality rates. Candidemia is the main invasive candidiasis and its epidemiology may vary among study location, local healthcare practices and studied countries. Therefore, the aim of this study was to characterize 79 bloodstream isolates from patients of the Hospital das Clínicas of Faculdade de Medicina de Ribeirão Preto, from June 2014 to November 2015. The Minimal Inhibitory Concentration of amphotericin B, caspofungin, fluconazole and voriconazole was determined using broth microdilution; virulence factor production was analyzed; and the strains were typed by Pulsed-field Gel Electrophoresis, Microsatellite Length Polymorphism and Multilocus Sequence Typing. As expected, C. albicans was the most predominant species (44%), followed by C. glabrata (19%), C. tropicalis (19%), C. parapsilosis (14%) and C. orthopsilosis (4%). In general, the strains did not show resistance to the tested antifungals. However, all C. glabrata and one C. parapsilosis isolates exhibited dose-dependent susceptibility to fluconazole, three C. glabrata isolates exhibited dose-dependent susceptibility to caspofungin, one C. albicans isolate was susceptible dose-dependent to voriconazole and one C. albicans isolate was resistant to fluconazole and voriconazole. Candida albicans strains were the main virulence attributes producer. C. glabrata isolates showed less genetic variability than the others studied species. The candidemia incidence was 1.52 per 1,000 admissions, and the mortality rate was 52%. The main risk factors were antibiotic therapy (86%), followed by urinary catheterization (68%), central venous access (60%), surgical procedures (54%), parenteral nutrition (42%) and neutropenia (14%). The most common underlying diseases were solid cancer (28%), diabetes (23%), gastrointestinal disease (20%) and liver disease (15%). Finally, the results are useful to bring a better comprehension of candidemia in the studied hospital and can help in the identification of efficient empirical treatment strategies (AU)