Abstract:

Background: In this study, candida species isolated from clinical samples of patients treated in intensive care units and other inpatient clinics pre-pandemic period (PPP) (April 1, 2018-March 31, 2020) and patients treated in COVID-19 intensive care units and other inpatient clinics during the pandemic period (PP) (1 April 2020-31 March 2022) were retrospectively examined. It was aimed to describe the variation of candida species and their antifungal susceptibility in PP according to PPP and contribute to our country's epidemiological data. Materials and Methods: Conventional methods and VITEK 2 (Biomerieux, France) automated system were used to identify candida species and determine their antifungal susceptibility. Species identifications of non-Candida albicans isolates were confirmed by the MALDI-TOF MS (Bruker Daltonik GmbH, Bremen, Germany) automated system. Antifungal susceptibilities were evaluated using the VITEK 2 automated system and gradient test strips (BioMérieux E test, France). Results: Fungal strains were detected in 125 (2%) of the clinical samples that came to our laboratory in the pre-pandemic period, and in 157(2.9%) during the PP. The increase in Candida isolates was statistically significant (p=0.007). It was observed that the growth rates in urine culture, blood culture and aspirate cultures increased in PP compared to PPP. The mean age of patients with candida isolated in PP is 70.86±14.53. An increase in the rates of male patients was observed in PP compared to PPP. Compared to PPP, an increase was observed in C.parapsilosis, C.glabrata and C.tropicalis species, and a decrease in C.kefyr species in PP. C.ciferrii, C.dubliniensis, C.sphaerica and C.zeylanoides have been isolated only in PP. It was observed that the susceptibility of C. albicans to amphotericin B, anidulafungin and voriconazole decreased in PP, and the susceptibilities of fluconazole, flucytosine and micafungin were increased. C.albicans, C.glabrata, C.parapsilosis, C.tropicalis isolates were observed to have decreased sensitivity to amphotericin B, anidulafungin and caspofungin in PP compared to PPP. Conclusions: It has been observed that there is an increase in secondary candida infections due to the prolonged hospitalization period and high-level steroid use in COVID-19 patients compared to the PPP. Our data revealed an increase in non-C.albicans species, particularly in C.parapsilosis, C.glabrata and C.tropicalis species, in agreement with other similar studies reported. The decrease in echinocandin and amphotericin B susceptibility in candida species suggests the necessity of rational antifungal use. Updating and presenting the changes in Candida species and their antifungal susceptibility at regular intervals is important for clinicians' empirical antifungal treatment approach.