Epidemiologia da colonização ou infecção por leveduras no trato urinário de pacientes submetidos a cateterização vesical internados em unidade de terapia intensiva
Arquivos
Data
1997
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
As infeccoes hospitalares fungicas sao uma importante causa de morbidade e mortalidade em pacientes internados em unidade de terapia intensiva (UTI), acometendo principalmente a corrente sanguinea e o trato urinario. Os objetivos da presente investigacao foram verificar prospectivamente a incidencia de candiduria hospitalar, associada ao uso de cateter vesical, determinar os fatores de risco e avaliar as carateristicas microbiologicas de leveduras isoladas de pacientes submetidos a cateter veiscal durante a internacao em UTI. No periodo de junho de 1995 a janeiro de 1996 foram estudados 70 pacientes adultos, internados onsecutivamente na Unidade de Terapia Intensiva do Hospital São Paulo-UNIFESP submetidos a cateter vesical que apresentavam uroculturas e hemoculturas negativas na admissao. Amostras de urina, sangue e secrecao vaginal foram sistematicamente coletadas na admissao do paciente e a cada 72 horas durante a internacao na unidade. Amostra final foi colhida 48 horas apos a alta da UTI. Os fatores de risco foram obtidos atraves de instrumento especifico. Hemoculturas foram incubadas no sistema semiautomatizado oBacteco (Becton Dixon). Processamento das amostras de sangue, urina e secrecao vaginal e identificacao das leveduras isoladas, foram realizados pelos metodos padronizados. O perfil de sensibilidade das leveduras aos antifungicos foi avaliado pela tecnica de microdiluicao em placa. Em 17 pacientes (24,3%) foram isoladas leveduras hospitalares a partir de 13 uroculturas (18,6%) e quatro hemoculturas (5,7%). As especies isoladas nas amostras de urina correspondem a Candida albicans (35,29%), Torulopsis glabrata (23,52%), Trichosporon spp (11,56%), C. krusei (5,8%). Foram recuperadas de hemocultura C.albicans (5,8%), C.famata (5,8%), C.parapsilosis (5,8%) e C.tropicalis (5,8%). Os testes de sensibilidade demostraram que quatro cepas de leveduras apresentaram CIM elevados para as drogas antifungicas (T.inkin, T.ovoides, C.krusei e C.albicans). Os fatores de risco encontrados foram o sexo feminino (RR=1,95; IC=1,1-3,46; p 0,04) e troca de cateter vesical (RR=13,15; IC=1,48-116,55; p=0,0185). Em 9/13 pacientes, a colonizacao aconteceu apos tres dias da instalacao do cateter urinario. Observamos resolucao espontanea de candiduria nos pacientes com a primeira urocultura apresentando unidades formadoras de colonias  20.000 mL. Cinco das oito pacientes com secrecao vaginal inicial positiva para leveduras, mostraram presenca posterior da mesma especie em amostras de urina
Fungal hospital acquires infections are important cause of morbidity and mortality in intensive care unit (ICU) patients. The main purpose of the present investigation was to assess demographic data, risk factors and microbiological informations of nosocomial candiduria in ICU patients. From June/95 to January/96, 70 consecutively impatients submitted to bladder catheterization were studied. Samples of urine, blood and vaginal secretion were collected at the moment of admission, every 72 hours during ICU hospitalization and after 48 hours ICU discharge. Potencial risk factors were analized. Isolation and identification of fungi were performed by standard methods. Yeast susceptibility profile to fungal agents was performed by the NCCLS-USA broth microdilution. From 17 patients (24.3%), the following yeast species yielded of urine cultures (13 patients) and bloot cultures (4 patients). The species recupered from urine cultured are Candida albicans (46.15%), Torulopsis glabrata (30.76%), Trichosporon spp (15.38%), C. krusei (7.69%) and recupered from blood culture C.albicans (5.8%), C.famata (5.8%), C.parapsilosis (5.8%) e C.tropicalis (5.8%). We had two isolate resistant to fluconazole (C. krusei and C.albicans) and two isolates resistant to amphotericin B (T.inkin and T.ovoides). The major risk factors were female sex (p=0.04). Yeast colonization took place three days following admission in nine out 13 patients. Spontaneously resolution of candiduria was observed in all patients with initial urine culture nearly 20.000 CUF/mL. From eigth patients with yeasts from initial vaginal secretion showed later in five patients the presence of the samme yeast-species from urine samples.
Fungal hospital acquires infections are important cause of morbidity and mortality in intensive care unit (ICU) patients. The main purpose of the present investigation was to assess demographic data, risk factors and microbiological informations of nosocomial candiduria in ICU patients. From June/95 to January/96, 70 consecutively impatients submitted to bladder catheterization were studied. Samples of urine, blood and vaginal secretion were collected at the moment of admission, every 72 hours during ICU hospitalization and after 48 hours ICU discharge. Potencial risk factors were analized. Isolation and identification of fungi were performed by standard methods. Yeast susceptibility profile to fungal agents was performed by the NCCLS-USA broth microdilution. From 17 patients (24.3%), the following yeast species yielded of urine cultures (13 patients) and bloot cultures (4 patients). The species recupered from urine cultured are Candida albicans (46.15%), Torulopsis glabrata (30.76%), Trichosporon spp (15.38%), C. krusei (7.69%) and recupered from blood culture C.albicans (5.8%), C.famata (5.8%), C.parapsilosis (5.8%) e C.tropicalis (5.8%). We had two isolate resistant to fluconazole (C. krusei and C.albicans) and two isolates resistant to amphotericin B (T.inkin and T.ovoides). The major risk factors were female sex (p=0.04). Yeast colonization took place three days following admission in nine out 13 patients. Spontaneously resolution of candiduria was observed in all patients with initial urine culture nearly 20.000 CUF/mL. From eigth patients with yeasts from initial vaginal secretion showed later in five patients the presence of the samme yeast-species from urine samples.
Descrição
Citação
VERGARA, Naldy Pamela Febre. Epidemiologia da colonização ou infecção por leveduras no trato urinário de pacientes submetidos a cateterização vesical internados em unidade de terapia intensiva. 1997. 81 f. Dissertação (Mestrado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, 1997.