FLUCONAZOLE SUSCEPTIBILITY IN CLINICAL ISOLATES OF Candida glabrata COMPLEX

The epidemiology of Candida glabrata infections is not well known yet; the infection occurs mainly after prophylactic use of antifungal agents, as fluconazole, in patients with haematological disease and is not associated with catheter use and previous antibiotic therapy. The infection by this species has assumed great importance in medical practice since the acquired resistance to fluconazole has been described. Besides, C. glabrata has been shown to decrease sensitivity to azoles in vitro. This species is an invasive infection agent and the monitoring effectiveness of antifungal agents used in the medical routine on isolated samples has clinical relevance. C. glabrata has been associated with high mortality, reaching 78%, being associated with candidemia in patients with severe neutropenic and from Intensive Care Units patients. In Brazil candidemia rates by C. glabrata increased from 3.0% to 11.2% between the years 2006 to 2011. In this study we evaluated the fluconazole sensitivity profile in C. glabrata complex clinical samples. 26 isolates with morphological and biochemical characteristics of C. glabrat, eight isolated from the oral cavity, two from the vaginal cavity and 16 from the bloodstream. The isolates were cultivated in the Chromagar Candida and the phenotypic identification of the species was performed by the microculture on Cornmeal agar added Tween 80. The minimum inhibitory concentrations (MIC) of fluconazole were determined by the microdilution methodology according to the European Committee on Antimicrobial Susceptibility Testing, AFST-EUCAST. The resistance to fluconazole was observed in 50.0% (13) of the C. glabrata isolates, of which 76.92% were isolated from the bloodstream. High MIC values of fluconazole (>32mg/L) according to the epidemiological cutoff were observed in all studied samples and the MIC values for fluconazole ranged from 0.5 mg/L to 128 mg/L in isolates from the oral cavity, from 2.0 mg/L to 128 mg/L in isolates from the bloodstream, and both isolates from the vaginal cavity showed a MIC of 32.0 mg/mL. These data indicate the prevalence of fluconazole resistant isolates and reinforce the need to monitor the activity of antifungal agents used in medical routine in order to optimize the treatment of C. glabrata infection cases, mainly in the bloodstream.