RESUMO
The aim of our study was to perform molecular typing on 25 clinical samples of Candida spp that were isolated from children with candidemia who were hospitalized in the neonatal intensive care unit of a university hospital between 1998 and 2006. Demographic and clinical data were obtained from the medical records to ascertain the clinical and epidemiological characteristics. Yeast identification was done using conventional methods and susceptibility to antifungals was assessed using a microdilution method. The genetic profile was determined using the RAPD-PCR technique. Candida albicans (11; 44%) and Candida parapsilosis (10; 40%) were the species most frequently isolated. Seventeen (68%) of the newborns weighed less than 1,500 g. Prematurity (92%) and use of a central venous catheter (100%) were the risk conditions with greatest association. Nineteen patients (76%) died. Only one strain of Candida parapsilosis showed dose-dependent sensitivity to fluconazole. Molecular analysis showed 11 distinct genetic patterns. An epidemiological relationship was seen in only two cases, thus suggesting the same source of infection.
Assuntos
Antifúngicos/farmacologia , Candida/classificação , Fluconazol/farmacologia , Fungemia/microbiologia , Brasil , Candida/efeitos dos fármacos , Candida/genética , DNA Fúngico/análise , Feminino , Hospitais Públicos , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Testes de Sensibilidade Microbiana , Técnicas de Tipagem Micológica , Técnica de Amplificação ao Acaso de DNA Polimórfico , Estudos Retrospectivos , Fatores de RiscoRESUMO
O objetivo de nosso estudo foi realizar tipagem molecular de 25 amostras clínicas de Candida spp, isoladas de crianças com candidemia, internadas na unidade de terapia intensiva neonatal de um Hospital Universitário entre 1998 a 2006. Dados demográficos e clínicos foram obtidos de prontuários para conhecimento dos aspectos clínicos e epidemiológicos. Identificação das leveduras foi feita por método convencional e a susceptibilidade antifúngica por método de microdiluição. O perfil genético foi determinado pela técnica de RAPD-PCR. Candida albicans (11; 44 por cento) e Candida parapsilosis (10; 40 por cento) foram as mais isoladas. Dezessete (68 por cento) dos recém-nascidos tinham peso inferior a 1.500g. Prematuridade (92 por cento), uso de cateter venoso central (100 por cento), foram as condições de risco mais associados. Dezenove (76 por cento) pacientes foram a óbito. Apenas uma cepa de Candida parapsilosis, mostrou ser sensível dose dependente ao fluconazol. Na análise molecular, foram observados 11 padrões genéticos distintos. Somente em dois casos foi observada relação epidemiológica, sugerindo mesma fonte de infecção.
The aim of our study was to perform molecular typing on 25 clinical samples of Candida spp that were isolated from children with candidemia who were hospitalized in the neonatal intensive care unit of a university hospital between 1998 and 2006. Demographic and clinical data were obtained from the medical records to ascertain the clinical and epidemiological characteristics. Yeast identification was done using conventional methods and susceptibility to antifungals was assessed using a microdilution method. The genetic profile was determined using the RAPD-PCR technique. Candida albicans (11; 44 percent) and Candida parapsilosis (10; 40 percent) were the species most frequently isolated. Seventeen (68 percent) of the newborns weighed less than 1,500g. Prematurity (92 percent) and use of a central venous catheter (100 percent) were the risk conditions with greatest association. Nineteen patients (76 percent) died. Only one strain of Candida parapsilosis showed dose-dependent sensitivity to fluconazole. Molecular analysis showed 11 distinct genetic patterns. An epidemiological relationship was seen in only two cases, thus suggesting the same source of infection.
