Identificação e perfil de suscetibilidade a antifúngicos em isolados de leveduras provenientes de uroculturas de pacientes internados no Hospital Universitário Onofre Lopes, Natal/RN

Abstract

Yeasts of the Candida genus are part of the human microbiota, colonizing mucosal surfaces of the respiratory, genitourinary, and gastrointestinal tracts. However, disruptions in the host-pathogen interaction can lead to opportunistic infections, such as urinary tract infections (UTIs). This study aimed to identify and evaluate the antifungal susceptibility profile of yeast isolates obtained from positive urine cultures collected between December 2023 and November 2024 at the Onofre Lopes University Hospital (Natal, RN, Brazil). Identification was performed using automated systems (Phoenix M50 or VITEK®2 compact), mass spectrometry (MALDI-TOF), and phenotypic methods, such as culture on CHROMagar Candida (Defcon). Antifungal susceptibility testing and determination of minimum inhibitory concentrations (MICs) followed the Brazilian Committee on Antimicrobial Susceptibility Testing (BrCAST, 2023) guidelines. Among the 48 isolates analyzed, Candida albicans was the most prevalent species (33.3%), followed by Nakaseomyces glabratus (29.4%) and Candida tropicalis (27.5%). No isolates showed resistance to amphotericin B (a polyene antifungal). Regarding the azole class, 18 isolates (37.5%) exhibited some degree of resistance: 14.3% of C. tropicalis (VigI-23 and VigI-43) to voriconazole; 5.9% of C. albicans (VigI-08), 14.3% of C. tropicalis (VigI-43 and VigI-67), and 6.7% of N. glabratus (VigI-57) to posaconazole; 11.8% of C. albicans (VigI-31, VigI-32), 28.6% of C. tropicalis (VigI-04, VigI-23, VigI-33, and VigI-35), 50% of C. parapsilosis (VigI-09), and 6.7% of N. glabratus (VigI-57) to itraconazole; and 7.1% of C. tropicalis (VigI-23) and 20% of N. glabratus (VigI-29, VigI-76A, and VigI-78A) to fluconazole. As for echinocandins, 3 isolates (6.25%) showed resistance: 50% of Pichia kudriavzevii (VigI-26B) to caspofungin; 6.7% of N. glabratus (VigI-24) to micafungin; and 7.1% of C. tropicalis (VigI-67), 50% of P. kudriavzevii (VigI-26B), and 6.7% of N. glabratus (VigI-65) to anidulafungin. These findings highlight the importance of continuous antifungal susceptibility monitoring to guide effective therapy and prevent the spread of resistance.