Antifungal drug susceptibility of yeast isolated from blood samples of patients with Severe COVID-۱۹ Admitted to ICUs Patients

Background and Aim : As a novel risk factor, COVID-۱۹ has led to an increase in the incidence of candidemia and an elevated mortality rate. Despite being of clinical importance, there is a lack of data regarding COVID-۱۹-associated candidemia (CAC) among Iranian patients. Therefore, in this retrospective study, we assessed CAC epidemiology and Antifungal susceptibility in the intensive care units (ICUs) of two COVID-۱۹ centers in Mashhad, Iran, from early November ۲۰۲۰ to late January ۲۰۲۱ Methods : Yeast isolates from patients’ blood were identified by ۲۱-plex polymerase chain reaction (PCR) and sequencing, then subjected to antifungal susceptibility testing according to the CLSI M۲۷-A۳ protocol. Results : The mortality of the limited CAC cases was high and greatly exceeded that of patients with COVID-۱۹ but without candidemia (۱۰۰% vs. ۲۲.۷%). Among ۱۹۸۸ patients with COVID-۱۹ admitted to ICUs, seven had fungemia and nine yeast isolates were collected, five Candida albicans, three C. glabrata, and one Rhodotorula mucilaginosa. Half of the patients infected with C. albicans (۲/۴) were refractory to both azoles and echinocandins. None of the C. glabrata isolates were resistant to the tested antifungal drugs. The R. mucilaginosa isolate showed high MICs of all azoles and echinocandins tested but a low MIC of AMB.Conclusion : In conclusion, our study revealed a high mortality rate among critically ill patients with COVID-۱۹ and candidemia in Iran, thus underscoring the importance of rapid diagnosis followed by the timely initiation of appropriate antifungal therapy.

Keywords:

Antifungal , COVID-۱۹ , candidemia , multidrug resistance