Epidemiology of candidemia in Shiraz, southern Iran: A prospective multicenter study (2016-2018).

Abstract

Systematic candidemia studies, especially in southern Iran, are scarce. In the current prospective study, we investigated candidemia in three major healthcare centers of Shiraz, the largest city in southern Iran. Yeast isolates from blood and other sterile body fluids were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and subjected to antifungal susceptibility testing (AFST) using the broth microdilution method. Clinical data were retrieved from patients' medical records. In total, 113 yeast isolates were recovered from 109 patients, over 60% of whom received fluconazole. Antifungal drugs were prescribed without considering species identification or AFST. The all-cause mortality rate was 28%. Almost 30% of the patients were from intensive care units (ICUs). Candida albicans (56/113; 49.5%) was the most prevalent species followed by C. glabrata (26/113; 23%), C. parapsilosis (13/113; 11.5%), C. tropicalis (7/113; 6.2%), and C. dubliniensis (5/113; 4.4%). Only five isolates showed antifungal resistance or decreased susceptibility to fluconazole: one C. orthopsilosis isolate from an azole-naïve patient and two C. glabrata, one C. albicans, and one C. dubliniensis isolates from patients treated with azoles, who developed therapeutic failure against azoles later. Our results revealed a low level of antifungal resistance but a notable rate of azole therapeutic failure among patients with candidemia due to non-albicans Candida species, which threaten the efficacy of fluconazole, the most widely used antifungal in southern regions of Iran. Candidemia studies should not be confined to ICUs and treatment should be administered based on species identification and AFST results.

• Authors: Amir Arastehfar, Samira Yazdanpanah, Mina Bakhtiari, Wenjie Fang, Weihua Pan, Shahram Mahmoudi, Keyvan Pakshir, Farnaz Daneshnia, Teun Boekhout, Macit Ilkit, David S Perlin, Kamiar Zomorodian, Farid Zand
• Journal: Medical mycology (Med Mycol) Vol. 59 Issue 5 Pg. 422-430 (May 04 2021) ISSN: 1460-2709 [Electronic] England
• PMID: 32692816 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © The Author(s) 2020. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology.

Chemical References

• Antifungal Agents
• Azoles
• Fluconazole

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Antifungal Agents (pharmacology, therapeutic use)
• Azoles (pharmacology, therapeutic use)
• Candida (drug effects, isolation & purification)
• Candidemia (drug therapy, epidemiology, microbiology, mortality)
• Child
• Child, Preschool
• Drug Resistance, Fungal
• Fluconazole (pharmacology, therapeutic use)
• Humans
• Infant
• Iran (epidemiology)
• Male
• Microbial Sensitivity Tests
• Middle Aged
• Prospective Studies
• Saccharomycetales (drug effects, isolation & purification)
• Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
• Treatment Failure