Identification and antifungal susceptibility of <i>Candida</i> species isolated from the urine of patients in a university hospital in Brazil

Lima, Gláucia Moreira Espíndola; Nunes, Maína de Oliveira; Chang, Marilene Rodrigues; Tsujisaki, Rosianne Assis de Sousa; Nunes, Joslaine de Oliveira; Taira, Cleison Ledesma; Thomaz, Danilo Yamamoto; Negro, Gilda Maria Bárbaro Del; Mendes, Rinaldo Pôncio; Paniago, Anamaria Mello Miranda

doi:10.1590/S1678-9946201759075

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Original Article • Rev. Inst. Med. trop. S. Paulo 59 • 2017 • https://doi.org/10.1590/S1678-9946201759075 copy

Identification and antifungal susceptibility of Candida species isolated from the urine of patients in a university hospital in Brazil

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ABSTRACT

The aim of this study was to identify Candida spp. isolated from candiduria episodes at a tertiary hospital in the Midwest region of Brazil, and to determine their susceptibility profiles to antifungal compounds. From May 2011 to April 2012, Candida spp. isolated from 106 adult patients with candiduria admitted to the University Hospital of the Federal University of Mato Grosso do Sul were evaluated. Both, species identification and susceptibility testing with fluconazole-FLC, voriconazole-VRC, and amphotericin B-AmB were carried out using the Vitek 2. To discriminate species of the C. parapsilosis complex, a RAPD-PCR technique using the RPO2 primer was performed. From the total of 106 isolates, 42 (39.6%) C. albicans and 64 (60.4%) Candida non-albicans (CNA) - 33 C. tropicalis, 18 C. glabrata, 5 C. krusei, 4 C. parapsilosis sensu stricto, 2 C. kefyr, 1 C. lusitaniae, and 1 C. guilliermondii were identified. All isolates were susceptible to AmB and VRC, whereas all C. glabrata isolates presented either resistance (5.6%) or dose-dependent susceptibility (94.4%) to FLC. The study of Candida spp. and their resistance profiles may help in tailoring more efficient therapeutic strategies for candiduria.

KEYWORDS:
Urine infections; Antifungal agents; Nosocomial candiduria; Candida species; Antifungal susceptibility

Candida species (n; %)	Amphotericin B (%)			Fluconazole (%)			Voriconazole (%)
Candida species (n; %)	R	SDD	S^* * (MIC ≤ 1 μg/mL);	R	SDD	S^ (MIC ≤ 2 μg/mL),	R	SDD	S^* ***** (MIC ≤ 0.12 μg/mL);
Candida albicans (42; 39.6)	0	0	100	0	0	100	0	0	100
Candida tropicalis (33; 31.1)	0	0	100	0	0	100	0	0	100
Candida glabrata (18; 17.0)	0	0	100	5.6^(a) (a) (MIC > 64 μg/mL);	94.4 ^(b) (b) (MIC ≤ 32 μg/mL).	0	0	0	100
Candida krusei (5; 4.7)	0	0	100	100	0	0	0	0	100
Candida parapsilosis (4; 3.8)	0	0	100	0	0	100	0	0	100
Candida kefyr (2; 1.9)	0	0	100	0	0	100	0	0	100
Candida guilliermondii (1; 0.9)	0	0	100	0	0	100	0	0	100
Candida lusitaniae (1; 0.9)	0	0	100	0	0	100	0	0	100

Variables		Resistant or SDD (n=23)	Susceptible (n=83)	p-value
Variables		n (%)	n (%)	p-value
Inpatient unit	ER/ICU	18 (78.3)	48 (57.8)	0.074
	Other	5 (21.7)	35 (42.2)
Age ≥60 years	No	6 (26.1)	31 (37.3)	0.316
	Yes	17 (73.9)	52 (62.7)
Sex	Female	14 (60.9)	44 (53.0)	0.503
	Male	9 (39.1)	39 (47.0)
CFU/mL	>100.000	22 (95.7)	70 (84.3)	0.294^* * Fisher's exact test.
	≤100.000	1 (4.3)	13 (15.7)
Leukocytes >5/field	No	2 (9.1)	13 (15.7)	0.732
	Yes	20 (90.9)	70 (84.3)

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[1] Correspondence to: Anamaria Mello Miranda Paniago Universidade Federal de Mato Grosso do Sul, Faculdade de Medicina, Av. Senador -Fillinto, Muller, 355, CEP 79070-900, Campo Grande, MS, Brazil Tel: +55 67 3345-7804 E-mails: anamaria.paniago@ufms.br; anapaniago@yahoo.com.br