SUSCEPTIBILITY OF Candida spp. ISOLATED FROM BLOOD CULTURES AS EVALUATED USING THE M27-A3 AND NEW M27-S4 APPROVED BREAKPOINTS

The high mortality rates associated with candidemia episodes and the emergence of resistance to antifungal agents necessitate the monitoring of the susceptibility of fungal isolates to antifungal treatments. The new, recently approved, species-specific clinical breakpoints (SS-CBPs)(M27-S4) for evaluating susceptibility require careful interpretation and comparison with the former proposals made using the M27-A3 breakpoints, both from CLSI. This study evaluated the susceptibility of the different species of Candida that were isolated from candidemias based on these two clinical breakpoints. Four hundred and twenty-two isolates were identified and, among them, C. parapsilosis comprised 46.68%, followed by C. albicans (35.78%), C. tropicalis (9.71%), C. glabrata (3.55%), C. lusitaniae (1.65%), C. guilliermondii (1.65%) and C. krusei (0.94%). In accordance with the M27-A3 criteria, 33 (7.81%) non-susceptible isolates were identified, of which 16 (3.79%) were resistant to antifungal agents. According to SS-CBPs, 80 (18.95%) isolates were non-susceptible, and 10 (2.36%) of these were drug resistant. When the total number of non-susceptible isolates was considered, the new SS-CBPs detected 2.4 times the number of isolates that were detected using the M27-A3 interpretative criteria. In conclusion, the detection of an elevated number of non-susceptible species has highlighted the relevance of evaluating susceptibility tests using new, species-specific clinical breakpoints (SS-CBPs), which could impact the profile of non-susceptible Candida spp. to antifungal agents that require continuous susceptibility monitoring

Influência da co-agregação entre Candida. albicans e Lactobacillus acidophilus na capacidade de adesão destes microrganismos às células epiteliais vaginais humanas (CEVH) = Influence of the co-aggregation between Candida. albicans e Lactobacillus acidophilus on the adhesion capacity these microorganisms in the human ephitelial vaginal cells (HEVC)

Este trabalho teve por objetivo avaliar a influência da co-agregação in vitro entre Candida albicans e Lactobacillus acidophilus na capacidade de adesão destes microrganismos às células epiteliais vaginais humanas (CEVH). Foram utilizados um isolado vaginal de C. albicans e uma cepa ATCC de L. acidophilus. Uma suspensão de cada microrganismo isoladamente e do coagregado foram incubados com as CEVH obtidas de uma doadora saudável. Foram feitos esfregaços por cristal violeta e Papanicolaou, e o número de leveduras, lactobacilos ou coagregados aderidos às células foi contado (em 300 células superficiais-CS e 300 intermediárias-CI). A Microscopia eletrônica de varredura (MEV) foi realizada em todas as situações dos ensaios.Leveduras e lactobacilos aderiram fortemente as CEVH, tanto em CS quanto em CI. A coagregação levou a um aumento na capacidade de adesão das leveduras (p < 0,001) e diminuiu a dos lactobacilos (p < 0,001). A adesão dos microrganismos isolados ou co-agregados nãoapresentou diferença entre CS e CI (p > 0,05). Havendo correlação com o que acontece in vivo, probióticos à base de L. acidophillus e mesmo uma flora lactobacilar vaginal não surtiriam efeito protetor contra a adesão de C. albicans as CEVH e do possível desenvolvimento de candidíase vulvovaginal.<br><br>This work has aimed to evaluate the influence of the L. acidophilus and Candida albicans co-aggregation on the adhesion capacity this microorganisms in the human ephitelial vaginal cells (HEVC). One vaginal isolated of C. albicans and one ATCC strain of L. acidophilus was used. A suspension of the isolated and co-aggregated microorganisms was incubated with HVEC obtained from a healthy donor. After one hour, smears were made with crystal violet and Papanicolaou, and the number of yeasts adhered to HVEC was evaluated (300 superficial-SC and 300 intermediate cells-IC). Scanning electron microscopy (SEM) was made in all situations of the assays. Yeasts and lactobacilli adhered strongly to the HEVC, both SC and IC. The co-aggregation there was an increase in the adhesion capacity of the yeasts (p < 0.001) and a diminished adhesion of the lactobacilli (p < 0.001) in SC and IC. The adhesion of isolated and co-aggregated microorganisms was not significantly different between SC and IC (p > 0.05). Supposing that of these findings correlated with the conditions in vivo, the use of probiotics based on L. acidophilus or its presence in the vaginal microbiota would not protect against the adhesion of C. albicans to the HVEC and possible consequent vulvovaginal candidiasis

SUSCEPTIBILITY OF Candida spp. ISOLATED FROM BLOOD CULTURES AS EVALUATED USING THE M27-A3 AND NEW M27-S4 APPROVED BREAKPOINTS

As elevadas taxas de mortalidade associadas com episódios de candidemia e a emergência da resistência aos antifúngicos, requerem o monitoramento da suscetibilidade de Candida spp., isoladas das candidemias, frente aos agentes antifúngicos. Os novos breakpoints, chamados “espécie-específicos,” foram recentemente aprovados (M27-S4) requerendo, pois, cuidadosa interpretação e comparações com aqueles até agora utilizados (M27-A3); ambos são propostos pelo Clinical Laboratory Standard Institute (CLSI). O presente estudo avaliou a suscetibilidade de espécies de Candida isoladas de candidemias baseando-se nestes dois breakpoints. Quatrocentos e vinte e dois isolados de Candida foram identificados e assim distribuídos: C. parapsilosis (48,68%), C. albicans (35,78%), C. tropicalis (9,71%), C. glabrata (3,55%), C. lusitaniae (1,65%), C. guilliermondii (1,65%), C. krusei (0,94%). Com base nos critérios do M27-A3, um total de 33 (7,81%) isolados foram julgados não-sensíveis, dos quais 16 (3,79%) como resistentes aos antifúngicos. De acordo com os breakpoints espécie-específicos (M27-S4) um total de 80 (18,95%) isolados foram considerados não-sensíveis, dos quais 10 (2,36%) resistentes a algum dos antifúngicos testados. Com base nos novos breakpoints espécie-específicos, o número de isolados não-sensíveis foi 2,4 vezes maior do que o número de não-sensíveis detectado pelos breakpoints do documento M27-A3. A detecção de um elevado número de isolados não-sensíveis através dos breakpoints propostos pelo M27-S4 destaca a importância dos testes de suscetibilidade, os quais trarão impactos no reconhecimento de isolados de Candida spp. não-sensíveis em episódios de candidemias, requerendo, portanto, continua avaliação.The high mortality rates associated with candidemia episodes and the emergence of resistance to antifungal agents necessitate the monitoring of the susceptibility of fungal isolates to antifungal treatments. The new, recently approved, species-specific clinical breakpoints (SS-CBPs)(M27-S4) for evaluating susceptibility require careful interpretation and comparison with the former proposals made using the M27-A3 breakpoints, both from CLSI. This study evaluated the susceptibility of the different species of Candida that were isolated from candidemias based on these two clinical breakpoints. Four hundred and twenty-two isolates were identified and, among them, C. parapsilosis comprised 46.68%, followed by C. albicans (35.78%), C. tropicalis (9.71%), C. glabrata (3.55%), C. lusitaniae (1.65%), C. guilliermondii (1.65%) and C. krusei (0.94%). In accordance with the M27-A3 criteria, 33 (7.81%) non-susceptible isolates were identified, of which 16 (3.79%) were resistant to antifungal agents. According to SS-CBPs, 80 (18.95%) isolates were non-susceptible, and 10 (2.36%) of these were drug resistant. When the total number of non-susceptible isolates was considered, the new SS-CBPs detected 2.4 times the number of isolates that were detected using the M27-A3 interpretative criteria. In conclusion, the detection of an elevated number of non-susceptible species has highlighted the relevance of evaluating susceptibility tests using new, species-specific clinical breakpoints (SS-CBPs), which could impact the profile of non-susceptible Candida spp. to antifungal agents that require continuous susceptibility monitoring