Clinical, epidemiological, and mycological features of patients with candidemia: Experience in two tertiary referral centers in Iran

Mohammad Kord; Mohammadreza Salehi; Seyed Jamal  Hashemi; Alireza Abdollahi; Neda Alijani; Ayda Maleki; Shahram Mahmoudi; Kazem Ahmadikia; Nasrin Parsameher; Masoud Moradi; Mahsa Abdorahimi; Sara Rezaie; Shirin Sadat  Hashemi Fesharaki; Kiana Abbasi; Laura  Alcazar-Fuoli; Sadegh Khodavaisy

doi:10.18502/cmm.8.3.11207

Mohammad Kord Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Mohammadreza Salehi Research center for antibiotic stewardship and antimicrobial resistance, Department of infectious diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Seyed Jamal Hashemi Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Alireza Abdollahi Department of Pathology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Neda Alijani Department of Infectious Diseases, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
Ayda Maleki Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Shahram Mahmoudi Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Kazem Ahmadikia Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Nasrin Parsameher Clinical Laboratory, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
Masoud Moradi Department of Biostatistics and Epidemiology, Faculty of Health, Mazandaran University of Medical Sciences, Sari, Iran
Mahsa Abdorahimi Department of Microbiology, Shahr-e-Qods Branch, Islamic Azad University, Tehran, Iran
Sara Rezaie Department of Chemistry and Biology, Ryerson University, Toronto, Canada
Shirin Sadat Hashemi Fesharaki Department of Molecular Pathology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
Kiana Abbasi Department of Microbiology, Zanjan Branch, Islamic Azad University, Zanjan, Iran
Laura Alcazar-Fuoli Mycology Reference Laboratory, National Centre for Microbiology, Instituto de Salud Carlos III, Madrid, Spain
Sadegh Khodavaisy Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/cmm.8.3.11207

Keywords: Antifungal susceptibility, Candidemia, Epidemiology, Iran, Risk factors

Abstract

Background and Purpose: Candidemia is a major cause of morbidity and mortality among patients receiving immunosuppressive therapy and those hospitalized with serious underlying diseases. Here, we investigated the epidemiological, clinical, and mycological features of candidemia in Tehran, Iran.

Materials and Methods: A prospective observational study of all patients diagnosed with candidemia was performed at two referral teaching hospitals in Tehran, Iran, from February to December 2018. Demographic characteristics, underlying diseases, risk factors, clinical symptoms, and laboratory analyses of candidemic patients with positive culture were mined. Candida isolates were molecularly identified by sequencing of the internal transcribed spacer region (ITS1-5.8S-ITS2). The antifungal susceptibility testing for fluconazole, itraconazole, voriconazole, posaconazole, amphotericin B, caspofungin, micafungin, and anidulafunginagainst the isolates was performed using CLSI broth microdilution reference method (M27-A3).

Results: A total of 89 episodes were identified, with an incidence of 2.1 episodes/1000 admissions. The common underling disease were malignancy (46%), renal failure/dialysis (44%), and hypertension (40%). The overall crude mortality was 47%. C. albicans (44%) was the most frequent causative agent, followed by C. glabrata (21%), C. parapsilosis complex (15%), C. tropicalis (11%), and C. lusitaniae (3.5%). All the isolates were susceptible to amphotericin B. The activity of all four azoles was low against non-albicans Candida species, especially C. tropicalis.

Conclusion: The increase in non-albicans Candida species with reduced susceptibility to antifungal drugs might be alarming in high-risk patients. Therefore, accurate knowledge of predisposing factors and epidemiological patterns in candidemia are effective steps for managing and decreasing the mortality rate in candidemia.