Our understanding of fungal epidemiology and the burden of antifungal drug resistance in COVID-19-associated candidemia (CAC) patients is limited. Therefore, we conducted a retrospective multicenter study in Iran to explore clinical and microbiological profiles of CAC patients. Yeast isolated from blood, 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 M27-A3 protocol. A total of 0.6% of the COVID-19 patients acquired CAC (43/6174). Fluconazole was the most widely used antifungal, and 37% of patients were not treated. Contrary to historic candidemia patients, C. albicans and C. tropicalis were the most common species. In vitro resistance was high and only noted for azoles; 50%, 20%, and 13.6% of patients were infected with azole-non-susceptible (ANS) C. tropicalis, C. parapsilosis, and C. albicans isolates, respectively. ERG11 mutations conferring azole resistance were detected for C. parapsilosis isolates (Y132F), recovered from an azole-naïve patient. Our study revealed an unprecedented rise in ANS Candida isolates, including the first C. parapsilosis isolate carrying Y132F, among CAC patients in Iran, which potentially threatens the efficacy of fluconazole, the most widely used drug in our centers. Considering the high mortality rate and 37% of untreated CAC cases, our study underscores the importance of infection control strategies and antifungal stewardship to minimize the emergence of ANS Candida isolates during COVID-19.

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COVID-19相关念珠菌血症：从真菌流行病学的转变到唑类耐药性的上升

我们对真菌流行病学和 COVID-19 相关念珠菌血症 (CAC) 患者抗真菌药物耐药性负担的了解有限。因此，我们在伊朗进行了一项回顾性多中心研究，以探讨 CA​​C 患者的临床和微生物学特征。从血液中分离出的酵母通过基质辅助激光解吸/电离飞行时间质谱进行鉴定，并使用肉汤微量稀释方法 M27-A3 方案进行抗真菌药敏测试 (AFST)。共有 0.6% 的 COVID-19 患者获得了 CAC (43/6174)。氟康唑是最广泛使用的抗真菌药物，37% 的患者未接受治疗。与历史上的念珠菌血症患者相反，白色念珠菌和热带念珠菌是最常见的物种。体外耐药性很高，仅针对唑类药物； 50%、20% 和 13.6% 的患者分别感染唑类不敏感 (ANS) 热带念珠菌、近平滑念珠菌和白色念珠菌分离株。从未接受过唑类药物治疗的患者体内回收的近平滑念珠菌分离株 (Y132F) 中检测到了赋予唑类耐药性的 ERG11 突变。我们的研究显示，伊朗 CAC 患者中 ANS 念珠菌分离株出现前所未有的增加，包括第一个携带 Y132F 的近平滑念珠菌分离株，这可能威胁到我们中心最广泛使用的药物氟康唑的疗效。考虑到高死亡率和 37% 的未经治疗的 CAC 病例，我们的研究强调了感染控制策略和抗真菌管理的重要性，以最大限度地减少 COVID-19 期间 ANS 念珠菌分离株的出现。