Candidíase invasiva em neonatos críticos: etiologia, patogenia e perfil molecular

Abstract

The increase in survival of preterm infants admitted to Neonatal Intensive Care Units (NICUs) is associated with an increase in the occurrence of invasive infections. The colonization of the hands of health professionals by pathogenic microorganisms capable of expressing virulence factors, such as Candida spp., Is worrisome due to the constant contact between patients and professionals in NICU. The objectives of this study were: to verify the rate of bacterial and fungal infections in a NICU of the Clinical Hospital of Federal University of Uberlândia, to characterize phenotypically isolated Candida spp. from the hands of health professionals in the neonatology department. The newborns included in the study were monitored daily through the NHSN system, with information such as: gestational age (GI), birth weight, use of invasive and antimicrobial devices, infections and length of hospital stay. Isolates from the hands of health professionals were evaluated for the production of virulence factors and antifungal susceptibility. The hemolytic activity and DNAse were investigated using blood agar and DNAse, respectively. Biofilm production was evaluated through the XTT sodium salt reduction ability and the evaluation of the susceptibility of the isolates to the antifungals was done through the broth microdilution methodology. The results of this study were: the hospital infection rate equals 12/1000 patient-days. GI, weight, SNAPPE> 24 and use of devices such as catheters, mechanical ventilation and parenteral nutrition were statistically significant for bacterial and fungal infections. Death was 2.6 times higher in those with fungal infection compared to those with bacterial infection. Fifty isolates of Candida spp. of which 19 were C. parapsilosis stricto sensu, three C. metapsilosis, one C. orthopsilosis, seven C. albicans, six C. famata, five C. lusitaniae, three C. krusei, two C. kefyr, two C. tropicalis, a C. glabrata and a C. guilliermondii. 49 isolates were able to express at least one of the three virulence factors studied, and 17 simultaneously expressed all 3 factors. Seventy-eight percent of the isolates were sensitive to the three antifungals. These results demonstrated the importance of constant epidemiological surveillance and measures of effective control of infections in the neonatology sector and that isolates of Candida from colonization of the hands of health professionals are able to express important factors of virulence.