Ocorrência de Candidemia em pacientes internados em um hospital público terciário em Goiânia-GO

Abstract

Nosocomial infections are those acquired in a period of stay in health facilities. Among these, candidemia stands out as the main cause of disease in patients with high mortality and morbidity. Candidemia´s protagonist are Candida albicans, C. parapsilosis, C. tropicalis and C. glabrata´s species, which cause disease resulting from pathogen-host imbalance, mainly in nosocomial environment. This study aimed at evaluating the frequency of hospital candidemia, as well as to associate several predisposing factors in hospitalized patients. The study was carried out in a high complexity public tertiary hospital in Goiânia, GO, from laboratory and clinical data collection of patients hospitalized at Hospital das Clínicas at Federal University of Goiás from 2016 to 2017. In data treatment, data were segregated between the group with candidemia (Experimental group) and those without candidemia (control group). For statistical analysis, Microsoft ® Excel 2007 program and SPSS ® for Windows ® program, version 21.0 were used. The study was approved by the Ethics and Research Committee of Federal University of Minas Gerais (UFMG) number: 2,728,306. The candidemia overall incidence was 0.8 cases / 1000 hospitalizations. From the total blood cultures for fungi, 1.91% (40) were positive, being mostly female individuals 52,4 (21). In Candida species assessment, 52.5% (21/40) were positive samples for Candida albicans and 47.5% (19/40) for non-albicans species were obtained, being C. tropicalis 17.5% (7/40) and C. krusei 10% (4/40) the most prevalent. Regarding the age, the most affected patients were adults from 41 to 59, 67.5% (27/40) with an average age of 55 and children from 0 to 5 affected by C. albicans. As for antibiotics used concomitantly with other medications, vancomycin 60% (24/40), metronidazole 50% (20/40) and cefepime 47.5% were more prevalent. When analyzing antibiotics with the control group, (p = 0.021) and meropenem (p = 0.033) were associated with risk of death (p = 0.001), vancomycin (p = 0.002) and cefepime (p = 0.020). As with antifungals, fluconazole 77.5% (31/40), amphotericin B 32.5% (13/40) and 25% (10/40) micafungin were the most used, and in the association with death, there was no statistical significance. It was concluded that overall candidemia incidence was considered low in the study, but the frequency of blood culture patients for Candida sp. was relatively high. It was obtained prevalence of C. albicans as an agent of candidemia in analyzed patients and inferred that the predisposing factors analyzed in the study favored the occurrence of candidemia in those individuals analyzed. Finally, new epidemiological and molecular studies should be performed aiming to contribute to a better understanding of Candida species involved.