Reply to Rodriguez et al and Mastrangelo et al

White, P. Lewis; Dhillon, Rishi; Healy, Brendan; Wise, Matthew Peter; Backs, Matthijs

doi:10.1093/cid/ciaa1597

Cited by 10 publications

(10 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The absence of C. parapsilosis among CAC-causative Candida may be attributed to a stricter infection control and environmental decontamination in the post-COVID-19 era; however, in the centers included in our study, the sanitation measures were less rigid and there was a surge of severe COVID-19 cases. The identification of C. albicans and C. glabrata as the leading agents of CAC is in line with the reports from Oman [ 9 ], Italy [ 21 ], and the United Kingdom [ 6 , 20 ]; still, this result does not rule out the possibility that other Candida spp. may cause outbreaks among critically ill patients with COVID-19, as evidenced by the finding that C. auris was the main causative species of CAC in India [ 7 ], Mexico [ 8 ], and Brazil [ 26 ].…”

Section: Discussionsupporting

confidence: 82%

“…Nonetheless, it was still much higher than the mortality rates reported from other multicenter candidemia studies conducted in Iran [ 22 , 30 , 31 ]. Although the mortality observed in this study is similar to that reported in Mexico (83%) [ 8 ], it is much higher than those documented in many other studies [ 3 , 5 , 6 , 7 , 8 , 9 , 10 , 25 ]. It is noteworthy that rapid diagnostic serology tools are not widely used in Mashhad because of their high cost [ 32 ], and physicians start antifungal treatment only after positive blood culture tests.…”

Section: Discussionsupporting

confidence: 79%

“…An increasing number of studies have documented a higher incidence of candidemia in the post-COVID-19 era and its association with high mortality despite antifungal treatment [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 20 ]. In this retrospective, multicenter study performed in Iran, we confirmed a high mortality rate among patients with CAC, which further highlights the vital importance of timely diagnosis and administration of proper antifungal treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, several studies have reported a high mortality rate for patients with COVID-19 co-infected with pathogenic fungi, both filamentous and yeast species [ 2 , 3 ]. An increasing body of evidence points to a higher incidence of candidemia in the post-COVID-19 than in the pre-COVID-19 era [ 4 , 5 , 6 ]. The mortality rate among patients with COVID-19-associated candidemia (CAC) is high [ 5 , 6 , 7 , 8 , 9 ], reaching up to 83% despite antifungal treatment [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Candidemia among Iranian Patients with Severe COVID-19 Admitted to ICUs

Arastehfar

Shaban

Zarrinfar

et al. 2021

JoF

View full text Add to dashboard Cite

As a novel risk factor, COVID-19 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-19-associated candidemia (CAC) among Iranian patients. Therefore, in this retrospective study, we assessed CAC epidemiology in the intensive care units (ICUs) of two COVID-19 centers in Mashhad, Iran, from early November 2020 to late January 2021. Yeast isolates from patients’ blood were identified by 21-plex polymerase chain reaction (PCR) and sequencing, then subjected to antifungal susceptibility testing according to the CLSI M27-A3 protocol. Among 1988 patients with COVID-19 admitted to ICUs, seven had fungemia (7/1988; 0.03%), among whom six had CAC. The mortality of the limited CAC cases was high and greatly exceeded that of patients with COVID-19 but without candidemia (100% (6/6) vs. 22.7% (452/1988)). In total, nine yeast isolates were collected from patients with fungemia: five Candida albicans, three C. glabrata, and one Rhodotorula mucilaginosa. Half of the patients infected with C. albicans (2/4) were refractory to both azoles and echinocandins. The high mortality of patients with CAC, despite antifungal therapy, reflects the severity of the disease in these patients and underscores the importance of rapid diagnosis and timely initiation of antifungal treatment.

show abstract

Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Candidemia among Iranian Patients with Severe COVID-19 Admitted to ICUs

Arastehfar

Shaban

Zarrinfar

et al. 2021

JoF

View full text Add to dashboard Cite

show abstract

“…According to published data, it is still not clear whether COVID-19 patients show a higher incidence of candidemia. Also, there is still no comparison of clinical presentation and outcomes between patients with and without COVID-19 available [ 12 , 13 , 14 ]. In our study in the year 2020, there were no COVID-19 patients among the patients with candidemia because the ward and intensive care unit for COVID-19 patients did not exist in the hospital until the end of 2020 and during our study period COVID-19 patients were transferred to other COVID-19-dedicated hospitals.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Candidemia: Three-Year Results from a Croatian Tertiary Care Hospital

Mareković

Pleško

Vranješ

et al. 2021

JoF

View full text Add to dashboard Cite

Invasive candidosis is the most common invasive fungal infection in hospitalized patients and is associated with a high mortality rate. This is the first study from a Croatian tertiary care hospital describing epidemiology, risk factors and species distribution in patients with candidemia. A three-year retrospective observational study, from 2018 to 2020, was performed at the University Hospital Centre Zagreb, Zagreb, Croatia. A total of 160 patients with candidemia (n = 170 isolates) were enrolled. Candidemia incidence increased from 0.47 to 0.69 per 1000 admissions in 2018 and 2020, respectively. Ninety-five patients (58.38%) were in the intensive care unit. The main risk factors for candidemia were central venous catheter (CVC) (84.38%), previous surgical procedure (56.88%) and invasive mechanical ventilation (42.50%). Candida albicans was identified in 43.53% of isolates, followed by C. parapsilosis (31.76%) and C. glabrata (12.36%), C. krusei (5.29%), C. tropicalis (2.35%) and C. lusitaniae (2.35%). The study discovered a shift to non-albicansCandida species, particularly C. parapsilosis, and made it possible to determine the main tasks we should focus on to prevent candidemia in the hospital, these being mainly infection control measures directed towards prevention of catheter-related bloodstream infections, specifically comprising hand hygiene and CVC bundles of care. The potential benefit of fluconazole prophylaxis in certain populations of surgical patients could also be considered.

show abstract

Assessment of Risk Factors and Clinical Outcomes in Hospitalized COVID-19 Patients with Candida spp. Co-infections: Species Distribution and Antifungal Susceptibility Patterns of Isolates

et al. 2022

View full text Add to dashboard Cite

Introduction Fungal co-infections are considered an important complication in hospitalized patients with SARS-CoV-2 that can be attributed to disease aggravation, increased mortality, and poor outcomes. This study was conducted to determine the species distribution and antifungal susceptibility patterns of Candida isolates from hospitalized COVID-19 patients in Shiraz, Iran, in addition to associated risk factors and outcomes of co-infections with Candida species. Materials and Methods In this single-center study, a total of 106 hospitalized COVID-19 patients were evaluated for clinical characteristics and outcomes. Species identification was performed by ITS1-5.8S-ITS2 gene sequencing. Antifungal susceptibility testing to fluconazole, itraconazole, voriconazole, posaconazole, caspofungin, amphotericin B, and nystatin was determined according to the M27-A3/S4 CLSI protocol. Results Candida species were recovered from 48% (51/106) of hospitalized COVID-19 patients. Statistical analysis showed that patients who had heart failure, bacterial co-infection, and were receiving empirical antifungal therapy had a higher risk of developing Candida co-infection. In total, 71 Candida isolates were recovered, of which C. albicans (69%) was the most prevalent isolate. The majority of the Candida isolates were susceptible to all classes of tested antifungal drugs. Discussion Our results elucidate a high rate of Candida co-infections among hospitalized COVID-19 patients. Comorbidities such as heart failure, HTN, COPD, bacterial infections as well as therapeutic interventions including catheterization, mechanical ventilation, and ICU admission increased the risk of Candida spp. isolation from the bloodstream, respiratory tract and urine samples, which led to a higher in-hospital mortality rate. Additionally, obtained data clarified that empirical antifungal therapy was not as successful as anticipated.

show abstract

Reply to Rodriguez et al and Mastrangelo et al

Cited by 10 publications

References 5 publications

Candidemia among Iranian Patients with Severe COVID-19 Admitted to ICUs

Candidemia among Iranian Patients with Severe COVID-19 Admitted to ICUs

Epidemiology of Candidemia: Three-Year Results from a Croatian Tertiary Care Hospital

Assessment of Risk Factors and Clinical Outcomes in Hospitalized COVID-19 Patients with Candida spp. Co-infections: Species Distribution and Antifungal Susceptibility Patterns of Isolates

Contact Info

Product

Resources

About