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 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, andmechanical 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.

Assessment of species distribution and virulence factors of oral fungal carriage among hospitalized patients with COVID-19: a case–control study

“…Oral fungal carriage refers to the harmless presence of fungi, such as Candida species, as a part of the normal oral microbiome 6 . The oral mycobiome and fungal carriage in COVID-19 patients can differ from healthy individuals due to factors like invasive treatments, the virus’s impact on the immune system, and multidrug therapies 7 .…”

“…During COVID-19 infection, physiological changes in the oral cavity, stemming from factors like medication misuse, compromised immunity, vascular issues, inflammation, and poor oral hygiene during treatment, contribute to oral fungal colonization. This disruption can lead to oral fungal infections 7 , 11 . The virulence characteristics of these organisms, such as the release of esterase, proteinases, and haemolytic abilities that are necessary to colonize and invade human organs, might nevertheless create oral mycoses in COVID-19 patients in addition to host-related causes 11 .…”

Epidemiologic and Antifungal Susceptibility Profile of Candiduria Among Patients Hospitalized in The Nephrology and Intensive Care Unit Wards, Tehran, Iran

“…Yeasts and yeast-like fungi are single-celled opportunistic organisms that reproduce through budding. Generally, yeasts are incapable of causing disease in healthy human and animal hosts; for that, they require a substantial break in the host's defense system (1). Candida species are the most common yeasts that cause fungal infections, especially urinary tract infections, and can cause candiduria (2).…”

“…Although Candida albicans is the most common cause of candiduria, non-albicans Candida species, particularly C. glabrata, and C. krusei, can be involved in the development of invasive candidiasis (1). Specific identification of Candida species helps choose the appropriate treatment because several non-albicans Candida species, such as C. krusei, are intrinsically resistant or less susceptible to several classes of antifungals, whereas others, including C. glabrata, develop acquired resistance following exposure to antifungal agents.…”

Risk factors and outcomes of fungal superinfections in patients with severe COVID-19: an observational study from Pisa academic hospital

“…Not only CAPA but also other fungal infections may complicate the course of COVID-19. Several recent studies reported an increasing incidence of candidaemia among COVID-19 patients [8][9][10][11][12]. Finally, other less common fungal infections, including pneumocystosis and mucormycosis, have been described in patients with severe COVID-19 [13][14][15].…”