Frequency, virulence factors and antifungal susceptibility of Candida parapsilosis species complex isolated from patients with candidemia in the central region of Argentina.

PURPOSE: Our objectives were to report species distribution and survival of patients with candidemia in Argentina's central region and to establish the prevalence of C.parapsilosis sensu lato species, their virulence factors and their antifungal susceptibility profiles. METHODS: Yeasts isolated from bloodstream infections in Córdoba (Argentina) (n=35) were molecularly identified. The production of lipase and acid aspartic protease (Sap), the adhesion capacity, and the isolates' ability to form biofilm were evaluated. The in vitro activity of 7 antifungal drugs was evaluated (CLSIdocument M27-4thed). RESULTS: C. albicans was the most prevalent species (48.57%) followed by C. parapsilosis sensu lato (28.57%). The 30-day survival rate for C. albicans candidemia was slightly lower than non-albicans blood infections (50.00% vs. 57.90%). C. parapsilosis sensu stricto and C. orthopsilosis account for 60% and 40% of the cryptic species. Sap production and biofilm formation capacity were higher in C. parapsilosis sensu strico than in C.orthopsilosis. All the strains were susceptible to caspofungin (CAS), anidulafungin (AFG), amphotericin B (AMB), posaconazole (POS) and voriconazole (VRC). Azoles were the most potent agent against C. parapsilosis sensu lato followed by echinocandins and AMB. There were no differences between MICs for fluconazole, VRC, POS and AMB. Contrarily, C. parapsilosis sensu stricto strains showed lower MIC than C. orthopsilopsis isolates for itraconazole and higher MIC values for echinocandins (P<0.01). CONCLUSIONS: We report a high frequency of isolation of C.orthopsilosis in candidemia patients of central region. Data on the prevalence, virulence capability and antifungal susceptibility of C. parapsilosis complex provide new epidemiological information about these cryptic species in Argentina.

Effectiveness of a clinical guide for the treatment of postoperative pain in a major ambulatory surgery unit.

A retrospective study to evaluate a clinical guide for the treatment of postoperative pain in our One Day Surgery Unit (ODSU) is presented. A total of 2783 patients, treated during 1 year, were studied. Postoperative pain was evaluated 24 h after surgery by phone-call using a visual analogue scale (VAS) and a verbal response scale (VRS). Results were analysed by groups of analgesia and pain scale values. Admissions due to insufficient analgesia were also evaluated. Mean values obtained in all analgesic groups in relation to the VAS were lower than 2.5. It was found that 86% of patients presented a value of VAS<3, while 84.6% had a VRS value 2. Only two patients were admitted for uncontrolled postoperative pain. The level of postoperative analgesia in our patients was satisfactory. Despite this continuous evaluation of the clinical guides for the treatment of postoperative pain, the use of new powerful analgesic drugs is necessary because the surgical complexity in ODSU is increasing and patients with associated diseases are increasingly accepted.