Suscetibilidade de isolados de Candida dubliniensis sensíveis e resistentes ao fluconazol frente a azólicos e equinocandinas

Abstract

Candida spp. is the most common etiologic agent of opportunistic fungal infections and Candida albicans species still remains the most frequently isolated species in candidiasis. However, the rate of Candida non-albicans isolates has increased in hospitals, where the use of azole antifungals for prophylaxis or therapy is frequent. The prolonged and indiscriminate use of antifungals has favored the development of resistant yeasts. In this context, other species have emerged as clinically important pathogens. Candida dubliniensis species is one that has become important because the easy way that acquires resistance to fluconazole, and may become a relatively more resistant pathogen and therefore more difficult to treat. This framework requires that measures of surveillance the susceptibility or investigations about the magnitude of the resistance are taken. This study aimed to evaluate and interpret the results of in vitro susceptibility of Candida dubliniensis sensitive and resistant to fluconazol and Candida albicans to echinocandins, voriconazole, itraconazole and posaconazole in the light of official documents and also by using proposed points of epidemiological cuts. Where evalued thre groups of isolates: a group of isolates of C. albicans against fluconazole sensitive (Group I), the other two isolates of C. dubliniensis, a compound of isolates sensitive to fluconazole (Group II) and other derived from the first fluconazole resistant (Group III). Groups I and II tests with fluconazole were shown to be susceptible to this antifungal and group III after exposure to increasing concentrations of fluconazole was classified as resistant based on document M27-S3 (2008) and in epidemiological cutoffs. The group I was considered 100% sensitive to antifungal agents based on documents M27-S4 (2012) and M27-S3 (2008). Group II was regarded as 100% sensitive to echinocandins, voriconazole, itraconazole, based on M27-S3 and 100% sensitive to posaconazole based on epidemiological cutoff. However, when interpreting the epidemiological cutoffs MICs, was observed 9.09% for non-sensitive isolates to micafungin. Finally, the group III was 100% sensitive to echinocandins, voriconazole, 100% itraconazole resistant to based on the M27-S3. Based on the epidemiological cutoffs, 4.54% were resistant to anidulafungin, 31.8% resistant to micafungin, 22.7% resistant or susceptible to voriconazole and 100% posaconazole sensitive. Evaluation of antifungal susceptibility is a complex issue and, at the time re-definitions of MICs defining susceptibility or resistance are under intense review, note difficulties in the interpretation of such tests.