Kamali Sarvestani Hasti, Mahmoudi Shahram, Afarinesh Khaki Pegah, Ansari Saham, Ghaderkhani Sara, Roostaei Davoud, Daei Ghazvini Roshanak, Hashemi Seyed Jamal, Rafat Zahra, Abollahi Alireza
Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Curr Med Mycol. 2021 Dec;7(4):12-18. doi: 10.18502/cmm.7.4.8406.
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.
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 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.
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 (n=7, 58.3 %) and (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.
Due to the high mortality, the early diagnosis and proper treatment of candidemia are essential requirements for optimal clinical outcomes in COVID-19 patients.
新型冠状病毒肺炎（COVID-19）大流行已引发全球健康危机。念珠菌血症是一种潜在的致命疾病，在COVID-19患者中尚未得到充分讨论。本研究旨在调查伊朗COVID-19患者中念珠菌血症的患病率，确定其病原体及抗真菌药敏模式。
本横断面调查于2020年3月至2021年3月在伊朗德黑兰伊玛目霍梅尼医院进行。从确诊冠状病毒感染且符合念珠菌血症标准的患者中采集血标本，采用传统和分子技术检测是否存在任何菌种。使用美国临床和实验室标准协会（CLSI）肉汤稀释技术检测分离株对两性霉素B、伏立康唑、伊曲康唑、氟康唑、卡泊芬净和5-氟胞嘧啶的敏感性。
共纳入153例COVID-19患者，其中12例（7.8%）确诊为念珠菌血症。大多数患者年龄≥50岁（n = 9），女性（n = 8）。此外，12例患者中有6例患有糖尿病。所有患者均观察到存在中心静脉导管、接受广谱抗生素治疗、入住重症监护病房（ICU）和机械通气。白色念珠菌（n = 7，58.3%）和光滑念珠菌（n = 2，16.7%）是最常见的分离菌种。两性霉素B和5-氟胞嘧啶是最有效的药物。尽管进行了抗真菌治疗，12例患者中有4例（33.3%）死亡。
由于死亡率高，念珠菌血症的早期诊断和恰当治疗是COVID-19患者获得最佳临床结局的必要条件。
