Fungal peritonitis in patients undergoing peritoneal dialysis (PD) in Brazil: molecular identification, biofilm production and antifungal susceptibility of the agents

Author(s)

Giacobino, Juliana ; Montelli, Augusto Cezar ; Barretti, Pasqual ; Bruder-Nascimento, Ariane ; Caramori, Jacqueline Teixeira ; Barbosa, Luciano ; Bagagli, Eduardo

• Document type: Journal article
• Source: Medical Mycology; v. 54, n. 7, p. 725-732, OCT 2016.
• Web of Science Citations: 9

Abstract

This paper presents data on fungal peritonitis (FP) in patients undergoing peritoneal dialysis (PD) at the University Hospital of Botucatu Medical School, Sao Paulo, Brazil. In a total of 422 patients, 30 developed FP, from which the medical records and the fungal isolates of 23 patient cases were studied. All patients presented abdominal pain, cloudy peritoneal effluent, needed hospitalization, had the catheter removed and were treated with fluconazole or fluconazole plus 5-flucitosine; six of them died due to FP. Concerning the agents, it was observed that Candida parapsilosis was the leading species (9/23), followed by Candida albicans (5/23), Candida orthopsilosis (4/23), Candida tropicalis (3/23), Candida guilliermondii (1/23), and Kodamaea ohmeri (1/23). All the isolates were susceptible to amphotericin B, voriconazole and caspofungin whereas C. albicans isolates were susceptible to all antifungals tested. Resistance to fluconazole was observed in three isolates of C. orthopsilosis, and dose-dependent susceptibility to this antifungal was observed in two isolates of C. parapsilosis and in the K. ohmeri isolate. Biofilm production estimates were high or moderate in most isolates, especially in C. albicans species, and low in C. parapsilosis species, with a marked variation among the isolates. This Brazilian study reinforces that FP in PD is caused by a diverse group of yeasts, most prevalently C. parapsilosis sensu stricto species. In addition, they present significant variation in susceptibility to antifungals and biofilm production, thus contributing to the complexity and severity of the clinical features. (AU)

• FAPESP's process: 12/07741-3 - ThrRS intein of species from the genus Candida: phylogeny, potential molecular marker and therapeutic target
• Grantee: Eduardo Bagagli
• Support Opportunities: Regular Research Grants
• FAPESP's process: 11/03836-7 - Phenotypic and molecular characterization of fungal species causing peritonitis in patients undergoing continuous ambulatory peritoneal dialysis from Clinical Hospital of UNESP, Botucatu
• Grantee: Juliana Giacobino
• Support Opportunities: Scholarships in Brazil - Master