Epidemiology, risk factors, species distribution, and antifungal susceptibility of candidemia among hospitalized patients with COVID-19

Hasti  Kamali Sarvestani; Shahram  Mahmoudi; Pegah   Afarinesh Khaki; Saham  Ansari; Sara  Ghaderkhani; Davoud  Roostaei; Roshanak  Daei Ghazvini; Seyed Jamal   Hashemi; Zahra Rafat; Alireza  Abollahi

doi:10.18502/cmm.7.4.8406

Hasti Kamali Sarvestani 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
Pegah Afarinesh Khaki Department of Molecular Genetics, Faculty of Advanced Science and Technology, Islamic Azad University, Tehran, Iran
Saham Ansari Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Sara Ghaderkhani Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Davoud Roostaei Department of Pharmacology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
Roshanak Daei Ghazvini Department of Medical Parasitology and Mycology, School of Public Health, 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
Zahra Rafat Department of Medical Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
Alireza Abollahi Department of Pathology, Imam Hospital Complex, Tehran University of Medical Sciences Tehran, Iran

DOI: https://doi.org/10.18502/cmm.7.4.8406

Keywords: Candidemia C. albicans C. dubliniensis COVID-19 Iran

Abstract

Background and Purpose: The pandemic of COVID-19 has caused a worldwide health crisis. Candidemia is a potentially lethal condition that has not yet been enough discussed in patients with COVID‐ 19. The current study aimed to investigate the prevalence of candidemia among Iranian COVID‐ 19 patients and characterize its causative agents and the antifungal susceptibility pattern.

Materials and Methods: The present cross-sectional survey was carried out from March 2020 to March 2021 at Imam Khomeini Hospital, Tehran, Iran. Blood specimens were obtained from patients with confirmed coronavirus infection who also had criteria for candidemia and were examined for any Candida species by conventional and molecular techniques. Susceptibility of isolates to amphotericin B, voriconazole, itraconazole, fluconazole, caspofungin, and 5-flucytosine was tested using the CLSI broth dilution technique.

Results: In total, 153 patients with COVID-19 were included and candidemia was confirmed in 12 (7.8 %) of them. The majority of patients were ≥ 50 years of age (n=9) and female (n=8). Moreover, 6 out of the 12 patients were diabetic. The presence of central venous catheters, broad-spectrum antibiotic therapy, ICU admission, and
mechanical ventilation was observed in all patients. The C. albicans (n=7, 58.3 %) and C. dubliniensis (n=2, 16.7%) were the most common isolated species. Amphotericin B and 5-flucytosine were the most active drugs. Despite antifungal treatment, 4 out of 12 patients (33.3 %) died.

Conclusion: Due to the high mortality, the early diagnosis and proper treatment of candidemia are essential requirements for optimal clinical outcomes in COVID-19 patients.