BACKGROUND Candida glabrata ranks second in epidemiological surveillance studies, and is considered one of the main human yeast pathogens. Treatment of Candida infections represents a contemporary public health problem due to the limited availability of an antifungal arsenal, toxicity effects and increasing cases of resistance. C. glabrata presents intrinsic fluconazole resistance and is a significant concern in clinical practice and in hospital environments. OBJECTIVE The aim of this study was to characterise the azole resistance mechanism presented by a C. glabrata clinical isolate from a Brazilian university hospital. METHODS Azole susceptibility assays, chemosensitisation, flow cytometry and mass spectrometry were performed. FINDINGS Our study demonstrated extremely high resistance to all azoles tested: fluconazole, voriconazole, posaconazole and itraconazole. This isolate was chemosensitised by FK506, a classical inhibitor of ABC transporters related to azole resistance, and Rhodamine 6G extrusion was observed. A mass spectrometry assay confirmed the ABC protein identification suggesting the probable role of efflux pumps in this resistance phenotype. MAIN CONCLUSIONS This study emphasizes the importance of ABC proteins and their relation to the resistance mechanism in hospital environments and they may be an important target for the development of compounds able to unsettle drug extrusion.

A candidíase tem se tornado uma importante preocupação para a prática clínica, especialmente com o aumento da incidência de pacientes imunocomprometidos. Neste cenário, o desenvolvimento da resistência ao fluconazol se apresenta como um desafio ao tratamento dessas infecções oportunistas. O objetivo deste estudo consistiu em avaliar alguns aspectos epidemiológicos das infecções por Candida em um hospital universitário brasileiro, utilizando dados, anteriormente, indisponíveis. Nós observamos que 44% dos 93 isolados clínicos testados pertenciam à espécie Candida albicans e 56%, a espécies Candidanão-albicans (principalmente Candida tropicalise Candida glabrata). A maioria das cepas foi isolada de amostras de urina, onde C. albicans foi predominantemente detectada. 29 cepas apresentaram um fenótipo de resistência ao fluconazol e destas, 22 foram quimiosensibilizadas pelo FK506, um inibidor clássico dos transportadores ABC, envolvidos na resistência aos azóis. Estes dados sugerem a provável participação das bombas de efluxo nesse fenótipo de resistência. Nosso estudo ressalta a necessidade do desenvolvimento de medidas de controle efetivas para as infecções fúngicas, o uso racional de antifúngicos e o desenvolvimento de novas moléculas capazes de inibir o transporte ativo de antifúngicos.

Candidiasis has become an important concern for clinical practice, especially with the increasing incidence of immunocompromised patients. In this scenario, the development resistance to fluconazole presents a challenge for treating these opportunistic infections. The aim of this study was to evaluate some epidemiology features of Candidainfections in a Brazilian University Hospital using data, previously unavailable. We observed that 44% of the 93 clinical isolates tested, belonged to Candida albicansspecies and 56% belonged to non-Candida albicansspecies (mainly Candida tropicalis and Candida glabrata). Most strains were isolated from urine samples where C. albicans was predominantly detected. 29 strains presented a fluconazole resistance phenotype and of these, 22 were chemosensitised by FK506, a classical inhibitor of ABC transporters related to azoles resistance. These data suggest the probable role of efflux pumps in this resistance phenotype. Our study highlights the need for developing effective control measures for fungal infections, rational use of antifungal drugs and development of new molecules able to abrogate the active transport of antifungals.

Descreve-se a evolução clínica de um caso de peritonite por Salmonella sp. após episódio de salmonelose intestinal, e uma breve revisão da literatura também foi realizada.

We describe the clinical course of a case of peritonitis caused by Salmonella sp. after an episode of intestinal salmonellosis, and a brief review of the literature is also done.