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

Document Type : Original Articles


1 Department of Medical Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran

2 Department of Parasitology and Mycology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

3 Department of Molecular Genetics, Faculty of Advanced science and Technology, Islamic Azad University, Tehran, Iran

4 Department of Medical Parasitology and Mycology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

5 Department of Infectious Diseases, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

6 Department. of Pharmacology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran

7 Department. of Medical Microbiology, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran

8 Department of Pathology, Imam Hospital Complex, Tehran University of Medical Sciences Tehran, Iran



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, and
mechanical 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.


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