Kord Mohammad, Salehi Mohammadreza, Hashemi Seyed Jamal, Abdollahi Alireza, Alijani Neda, Maleki Ayda, Mahmoudi Shahram, Ahmadikia Kazem, Parsameher Nasrin, Moradi Masoud, Abdorahimi Mahsa, Rezaie Sara, Hashemi Fesharaki Shirin Sadat, Abbasi Kiana, Alcazar-Fuoli Laura, Khodavaisy Sadegh
Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
Research center for antibiotic stewardship and antimicrobial resistance, Department of infectious diseases and Tropical Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Curr Med Mycol. 2022 Sep;8(3):9-17. doi: 10.18502/cmm.8.3.11207.
Candidemia is a major cause of morbidity and mortality among patients receiving immunosuppressive therapy and those hospitalized with serious underlying diseases. Here, we investigated the epidemiological, clinical, and mycological features of candidemia in Tehran, Iran.
A prospective observational study of all patients diagnosed with candidemia was performed at two referral teaching hospitals in Tehran, Iran, from February to December 2018. Demographic characteristics, underlying diseases, risk factors, clinical symptoms, and laboratory analyses of candidemic patients with positive culture were mined. isolates were molecularly identified by sequencing of the internal transcribed spacer region (ITS1-5.8S-ITS2). The antifungal susceptibility testing for fluconazole, itraconazole, voriconazole, posaconazole, amphotericin B, caspofungin, micafungin, and anidulafungin against the isolates was performed using CLSI broth microdilution reference method (M27-A3).
A total of 89 episodes were identified, with an incidence of 2.1 episodes/1000 admissions. The common underling disease were malignancy (46%), renal failure/dialysis (44%), and hypertension (40%). The overall crude mortality was 47%. (44%) was the most frequent causative agent, followed by (21%), complex (15%), (11%), and (3.5%). All the isolates were susceptible to amphotericin B. The activity of all four azoles was low against species, especially .
The increase in non- species with reduced susceptibility to antifungal drugs might be alarming in high-risk patients. Therefore, accurate knowledge of predisposing factors and epidemiological patterns in candidemia are effective steps for managing and decreasing the mortality rate in candidemia.
念珠菌血症是接受免疫抑制治疗的患者以及患有严重基础疾病住院患者发病和死亡的主要原因。在此，我们调查了伊朗德黑兰念珠菌血症的流行病学、临床和真菌学特征。
2018年2月至12月，在伊朗德黑兰的两家转诊教学医院对所有诊断为念珠菌血症的患者进行了一项前瞻性观察研究。挖掘念珠菌血症患者的人口统计学特征、基础疾病、危险因素、临床症状以及培养阳性患者的实验室分析结果。通过对内部转录间隔区（ITS1-5.8S-ITS2）进行测序对分离株进行分子鉴定。使用CLSI肉汤微量稀释参考方法（M27-A3）对分离株进行氟康唑、伊曲康唑、伏立康唑、泊沙康唑、两性霉素B、卡泊芬净、米卡芬净和阿尼芬净的抗真菌药敏试验。
共识别出89例病例，发病率为2.1例/1000次入院。常见基础疾病为恶性肿瘤（46%）、肾衰竭/透析（44%）和高血压（40%）。总粗死亡率为47%。白色念珠菌（44%）是最常见的病原体，其次是光滑念珠菌（21%）、近平滑念珠菌复合体（15%）、热带念珠菌（11%）和季也蒙念珠菌（3.5%）。所有分离株对两性霉素B敏感。所有四种唑类药物对非白色念珠菌属的活性较低，尤其是光滑念珠菌。
对高危患者而言，对抗真菌药物敏感性降低的非白色念珠菌属的增加可能令人担忧。因此，准确了解念珠菌血症的诱发因素和流行病学模式是管理和降低念珠菌血症死亡率的有效措施。
