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

Abstract

Background and Purpose: The pandemic of COVID-19 has caused a worldwide healthcrisis. 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 itscausative agents and the antifungal susceptibility pattern.Materials and Methods: The present cross-sectional survey was carried out fromMarch 2020 to March 2021 at Imam Khomeini Hospital, Tehran, Iran. Bloodspecimens were obtained from patients with confirmed coronavirus infection who alsohad 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 testedusing the CLSI broth dilution technique.Results: In total, 153 patients with COVID-19 were included and candidemia wasconfirmed 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 ofcentral venous catheters, broad-spectrum antibiotic therapy, ICU admission, andmechanical ventilation was observed in all patients. The C. albicans (n=7, 58.3 %) andC. dubliniensis (n=2, 16.7%) were the most common isolated species. Amphotericin Band 5-flucytosine were the most active drugs. Despite antifungal treatment, 4 out of 12patients (33.3 %) died.Conclusion: Due to the high mortality, the early diagnosis and proper treatment ofcandidemia are essential requirements for optimal clinical outcomes in COVID-19 patients.

Keywords

• candidemia
• c. albicans
• c. dubliniensis
• covid-19
• iran