Candidemia among Iranian Patients with Severe COVID-19 Admitted to ICUs

Arastehfar, Amir; Shaban, Tahmineh; Zarrinfar, Hossein; Roudbary, Maryam; Ghazanfari, Mona; Hedayati, Mohammad Taghi; Sedaghat, Alireza; İlkit, Macit; Najafzadeh, Mohammad Javad; Perlin, David S.

doi:10.3390/jof7040280

Cited by 68 publications

(89 citation statements)

References 34 publications

(73 reference statements)

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“…The 30-day mortality in this population was 89.5%, which is higher than the overall reported mortality of 68.5% (217/317) from ventilated patients at HUMC in the comparable time period [ 67 ]. The elevated mortality rate in COVID-19 patients with fungal superinfections, irrespective of the drug resistance profile of the infecting organism, is in agreement with other reports on COVID-19-associated candidemia [ 11 , 12 , 68 ].…”

Section: Discussionsupporting

confidence: 91%

Antifungal Drug Susceptibility and Genetic Characterization of Fungi Recovered from COVID-19 Patients

Kordalewska

Guerrero

Garcia-Rubio

et al. 2021

JoF

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Fungal infections are common complications of respiratory viral infections and are associated with the increased need for intensive care and elevated mortality. Data regarding microbiological and molecular characteristics of such infections in COVID-19 patients are scarce. Here, we performed a comprehensive analysis, including species identification, antifungal susceptibility testing, molecular resistance determinants analysis, typing, and retrospective clinical data review, of fungal isolates recovered from 19 COVID-19 patients, who were hospitalized at the Hackensack University Medical Center (HUMC) in Hackensack, New Jersey, USA, in the initial phase of the pandemic from April–May 2020. In total, 17 Candida albicans, two C. parapsilosis, and two Aspergillus fumigatus were analyzed. All Candida spp. isolates were susceptible to micafungin and azole drugs (fluconazole, voriconazole, posaconazole, itraconazole, isavuconazole). A. fumigatus isolates were susceptible to micafungin and all triazole drugs except fluconazole (intrinsic resistance). Multilocus sequence typing (MLST) of C. albicans isolates revealed 15 different sequence types (STs), which clustered below the clade-defining limit of p-distance < 0.04. Pulsed-field gel electrophoresis (PFGE) karyotyping revealed no chromosomal rearrangements in these isolates. A. fumigatus isolates were of different, non-related genotypes. We speculate that virus- and drug-induced immunosuppression (94.7% of the patients received corticosteroids), together with prolonged hospital stay (median duration of 29 days) and mechanical ventilation (median duration of 24 days) likely increased the susceptibility to secondary respiratory and bloodstream infections in the studied patient population. The presence of fungi in blood or respiratory tract fluid was a prognosticator for poor clinical outcome, which presented as an 89.5% 30-day mortality in our patient cohort.

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Section: Discussionsupporting

confidence: 91%

Antifungal Drug Susceptibility and Genetic Characterization of Fungi Recovered from COVID-19 Patients

Kordalewska

Guerrero

Garcia-Rubio

et al. 2021

JoF

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“…Prospective and retrospective data of COVID-19 patients admitted to intensive care units (ICU), especially for a prolonged duration, show that these patients are susceptible to invasive microbial co-infections during hospitalization and that these may lead to more severe outcomes [ 3 , 7 , 16 , 31 ]. A prospective cohort study of 135 adults, performed across multiple centers in Wales, showed a significantly higher (up to 25%) mortality rate in COVID-19 patients with fungal infections compared to patients without fungal infections [ 7 ].…”

Section: Fungal Co-infections In Covid-19 Disease: Disease Severity the Emergence Of Multidrug Resistance And Mucormycosismentioning

confidence: 99%

“…Reports from Italy indicate that up to 57.1% and 50% mortality was reported in COVID-19 patients with candidemia [ 57 ] and Candida auris candidemia [ 27 ], respectively. Elsewhere, the mortality rate of COVID-19 patients with candidemia exceeded those of counterparts without candidemia in Iran (100% vs. 22.7%) [ 31 ]. Altogether, these observations highlight and re-emphasize the propensity of fungal co-infections to exacerbate disease severity and, consequently, increase the mortality of critically ill patients admitted to the ICUs.…”

Section: Fungal Co-infections In Covid-19 Disease: Disease Severity the Emergence Of Multidrug Resistance And Mucormycosismentioning

confidence: 99%

“… Distribution ( a ) and co-occurrence ( b ) of fungal species across randomly selected 50 case studies, prospective and retrospective published reports on fungal co-infections in hospitalized COVID-19 patients [ 5 , 7 , 9 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 ] (also see Supplementary Table S1 ). Searches were done on PubMed (Medline) and Google Scholar using query terms such as “Co-infections”, “coinfections”, “fungi” or “Fungal infections” in combination with either “COVID-19” or “SARS-CoV-2”.…”

Section: Figurementioning

confidence: 99%

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Risk Factors for Fungal Co-Infections in Critically Ill COVID-19 Patients, with a Focus on Immunosuppressants

Ezeokoli

Gcilitshana

Pohl

2021

JoF

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Severe cases of coronavirus disease 2019 (COVID-19) managed in the intensive care unit are prone to complications, including secondary infections with opportunistic fungal pathogens. Systemic fungal co-infections in hospitalized COVID-19 patients may exacerbate COVID-19 disease severity, hamper treatment effectiveness and increase mortality. Here, we reiterate the role of fungal co-infections in exacerbating COVID-19 disease severity as well as highlight emerging trends related to fungal disease burden in COVID-19 patients. Furthermore, we provide perspectives on the risk factors for fungal co-infections in hospitalized COVID-19 patients and highlight the potential role of prolonged immunomodulatory treatments in driving fungal co-infections, including COVID-19-associated pulmonary aspergillosis (CAPA), COVID-19-associated candidiasis (CAC) and mucormycosis. We reiterate the need for early diagnosis of suspected COVID-19-associated systemic mycoses in the hospital setting.

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“…For this reason, it is important to set a protocol to rapidly identify it in hospitalized patients; thus, health-care facilities can take special precautions and implementing effective infection control measures to stop its spread especially because some commonly used health-care disinfectants are not sufficiently effective against C. auris leads to its persistence in health-care environments for several weeks [8].…”

Section: Introductionmentioning

confidence: 99%

Setting a Protocol for Identification and Detecting the Prevalence of Candida auris in Tertiary Egyptian Hospitals Using the CDC Steps

Khairat

Anany

Ashmawy

et al. 2021

Open Access Maced J Med Sci

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BACKGROUND: Candida is considered the most common cause of opportunistic infections in the world. Increased use of antifungal agents may have led to increasing resistance of Candida for antifungals and may be related to therapeutic failures. Recently, a multidrug-resistant Candida auris has immerged causing outbreaks in several countries all over the world. This discovered superbug is widely spread causing a broad range of health care-associated infections. AIM: This study aims to set a protocol for the identification and detection of the prevalence of C. auris in tertiary Egyptian hospitals following the center of disease and control (CDC) methodology. METHODOS: Over almost 2 years, 400 Candida isolates were collected from different wards of Cairo University Hospitals. Identification of species of all isolates was done by germ tube test followed by sub-culturing on chromogenic agar media for confirmation. Candida non-albicans isolates were further subjected to thermotolerance. Isolates that grew in 42°C were further identified by matrix-assisted laser desorption/ionization-time of flight (MALDI-TOF) mass spectrometry for definite species identification. Antifungal susceptibility using E-test was done for isolates identified by MALDI to detect resistance patterns. RESULTS: Among the 400 isolates, 227 (56.75%) were Candida albicans while 180 (43.25%) were non-albicans Candida. Candida non-albicans was classified by Chromagar as following; 25 (13.8%) were Candida tropicalis, 43 (23.8%) were Candida krusei, and 112 (62.2%) were other Candida spp. (Candida glabrata, Candida kefyr, Candida parapsilosis, and Candida lusitaniae). Using thermotolerance, 10 isolates grew at 42°C suspecting C. auris. MALDI-TOF was used for definite and final identification; five isolates were identified as C. glabrata, four as C. krusei, and one C. kefyr. Antifungal susceptibility testing of the 10 identified isolates revealed total resistance to fluconazole. CONCLUSION: Following the set protocol for identification based on CDC guidelines, C. auris is not prevalent in Egyptian hospitals. Fluconazole resistance is on the surge among candida isolates. Further studies on a bigger scale including larger number of hospitals are recommended.

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Candidemia among Iranian Patients with Severe COVID-19 Admitted to ICUs

Cited by 68 publications

References 34 publications

Antifungal Drug Susceptibility and Genetic Characterization of Fungi Recovered from COVID-19 Patients

Antifungal Drug Susceptibility and Genetic Characterization of Fungi Recovered from COVID-19 Patients

Risk Factors for Fungal Co-Infections in Critically Ill COVID-19 Patients, with a Focus on Immunosuppressants

Setting a Protocol for Identification and Detecting the Prevalence of Candida auris in Tertiary Egyptian Hospitals Using the CDC Steps

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