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. 2022 Sep;8(3):9-17.
doi: 10.18502/cmm.8.3.11207.

Clinical, epidemiological, and mycological features of patients with candidemia: Experience in two tertiary referral centers in Iran

Mohammad Kord  1 , Mohammadreza Salehi  2 , Seyed Jamal Hashemi  1 , Alireza Abdollahi  3 , Neda Alijani  4 , Ayda Maleki  1 , Shahram Mahmoudi  5 , Kazem Ahmadikia  1 , Nasrin Parsameher  6 , Masoud Moradi  7 , Mahsa Abdorahimi  8 , Sara Rezaie  9 , Shirin Sadat Hashemi Fesharaki  10 , Kiana Abbasi  11 , Laura Alcazar-Fuoli  12 , Sadegh Khodavaisy  1
Affiliations

Clinical, epidemiological, and mycological features of patients with candidemia: Experience in two tertiary referral centers in Iran

Mohammad Kord et al. Curr Med Mycol. 2022 Sep.

Abstract

Background and purpose: 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.

Materials and methods: 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. Candida 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).

Results: 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%. C. albicans (44%) was the most frequent causative agent, followed by C. glabrata (21%), C. parapsilosis complex (15%), C. tropicalis (11%), and C. lusitaniae (3.5%). All the isolates were susceptible to amphotericin B. The activity of all four azoles was low against non-albicans Candida species, especially C. tropicalis.

Conclusion: The increase in non-albicans Candida 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.

Keywords: Antifungal susceptibility; Candidemia; Epidemiology; Iran; Risk factors.

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Conflict of interest statement

The authors have no conflicts of interest to declare that are relevant to the content of this article.

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