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Cockroaches are widely recognized as vectors for transmitting pathogenic microorganisms in hospital and community environments due to their movement between contaminated and human-occupied spaces. Staphylococcus aureus (S. aureus), particularly methicillin-resistant Staphylococcus aureus (MRSA), is a primary global health concern because of its capacity to cause a wide range of infections and its resistance to many antibiotics. Despite efforts to control nosocomial infections, the role of cockroaches in disseminating antibiotic-resistant bacteria has not been fully explored. This study aims to investigate the antibiotic resistance patterns, biofilm formation, and genetic characteristics of S. aureus isolated from cockroaches in hospital environments. Understanding the role of cockroaches as vectors of drug-resistant S. aureus can contribute to developing more effective infection control strategies in healthcare settings. This study examined 386 cockroaches, including 230 American and 156 German cockroaches. Antibiotic sensitivity, inducible resistance, and biofilm formation were evaluated. The presence of mecA, ermA, ermB, ermC, msrA, icaA, icaB, icaC, icaD, SCCmec, mupA, mupB, and iles-1 genes was determined. Randomly amplified polymorphic DNA typing was performed to determine genetic relatedness. Fifty S. aureus isolates were identified, with 48 % confirmed as MRSA. No isolate exhibited constitutive resistance to clindamycin. However, 96 % of the isolates displayed inducible clindamycin resistance (iMLSB phenotype) when tested using the D-test. The prevalence of icaA, icaB, icaC, and icaD genes were 34 %, 8 %, 0 %, and 0 %, respectively. So, 29.1 %, 16.6 %, 12.5 %, and 8.3 % of isolates had SCCmec gene cassettes of types I, II, III, and IV, respectively. The prevalence of ermA, ermB, ermC, and msrA genes was found to be 18 %, 16 %, 58 %, and 4 %, respectively. Seven different clusters were found in the RAPD-PCR, with cluster A (5 isolates) being the most common. These results show that cockroaches are important in transmitting resistance factors as mechanical vectors. Therefore, taking sanitary measures to control the insect population is unavoidable.

Abstract Background The aim of the present study was to compare the epidemiological patterns of severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infections, hospitalizations, deaths, and duration of hospitalization during the fourth, fifth and sixth epidemic waves of coronavirus disease 2019 (COVID-19) in Iran. Methods A multicenter retrospective observational study was conducted on hospitalized patients in four hospitals in the Babol district of northern Iran. The study periods were during the fourth, fifth, and sixth waves of the epidemic in Iran, (March 2021 to March 2022). A total of 13,312 patients with suspected COVID-19 were included. Patient demographics, medical history, length of hospital stay, and clinical outcomes were obtained from the hospital information system. Data on the cycle threshold (Ct) and SARS-CoV2 variant were collected for SARS-CoV2-positive cases. Results The highest number of hospitalized patients was reported during the fifth (Delta) wave (5231; 39.3%), while the lowest number of hospitalized patients was reported during the sixth (Omicron) wave (2143; 16.1%). In total, 6459 (48.5%) out of 13,312 hospitalized patients with suspected COVID-19 had a positive rRT-PCR result. The fifth (Delta) wave had the highest number of SARS-CoV2 rRT-PCR-positive hospitalized patients (3573, 55.3%), while the sixth (Omicron) wave had the lowest number (835, 12.9%). Moreover, 238 (3.7%) patients with laboratory-confirmed COVID-19 died. The hospital mortality rate was 6.8% in the fourth (Alpha) wave, which reduced to 2.7 and 3.5% in the fifth (Delta) and sixth (Omicron) waves, respectively (p

Background and Purpose: The COVID-19 pandemic may be an aggravating risk factor for the delay of the diagnoses of serious illnesses, such as oral squamous cell carcinoma, as well as poor management of patients with underlying morbidities, the onset of oral lesions, and antifungal susceptibility to opportunistic fungal infections. Oral candidiasis is one of the most common oral features of COVID-19.Case Report: This study aimed to report an 83-year-old female diagnosed with oral carcinoma who developed oropharyngeal candidiasis after falling ill with COVID-19. In late 2020, this patient was hospitalized for COVID-19 pneumonia. A fissured tongue with white scars appeared after the COVID-19 recovery that caused pain, dysphasia, and dysarthria. The sequencing result based on the internal transcribed spacer rDNA region confirmed Candida glabrata. Its antifungal susceptibility showed susceptibility to nystatin, fluconazole, and caspofungin, but resistance to the other azoles and amphotericin B.Conclusion: Risk of fungal infections, such as Candida seems to be high in patients with severe COVID-19, mainly affecting the oral mucosa. However, whether they are directly attributed to COVID-19 or other surrounding factors is unknown.

Background and purpose: There is an increasing rate of drug resistance to azole among Candida species, so, finding new compounds that are effective in laboratory conditions, such as 3,4-dihydropyrimidine derivatives are important. The purpose of this study was to evaluate the antifungal sensitivity of 3,4-di-hydropyrimidine-1- (H2) -L- H1-pyrrole derivatives in Candida isolates. Materials and methods: Antifungal sensitivity of 102 Candida isolates with the origin of otomycosis to dihydropyrimidine derivatives and itraconazole were evaluated by broth microdilution according to CLSI-M27S4 guidelines. The serial dilution range of compounds and antifungal drug was 0.016-16 μg/ml. A concentration of compounds that showed at least 50% growth inhibition compared to the positive control group was considered as the minimum inhibitory concentration (MIC). Statistical analysis was performed in SPSS V16. Results: Findings showed that 3,4-di-hydropyrimidine-1-(H2)-L-H1-pyrrole derivatives have higher MIC than itraconazole against Candida species. Also, comparing the MIC values of 3,4-di- hydropyrimidine with each other (P1-P4), P1 derivatives were found with lower MIC values than the other three derivatives and almost all compounds showed more efficacy against Candida albicans than other Candida species. Conclusion: Although the antifungal effects of 3,4-dihydropyrimidine-1-(H2)-L-H1-pyrrole derivatives against Candida species were lower than itraconazole, but, making structural changes in these compounds can increase their antifungal effects.

Background and Purpose: Given the high mortality rate of invasive candidiasis inhospitalized pediatric patients, it is crucial to establish a predictive system to achieveearly diagnosis and treatment of patients who are likely to benefit from early antifungal treatment. This study aimed to assess the Candida colonization index, species distribution, and antifungal susceptibility pattern of Candida strains isolated frompediatric patients with high Candida colonization index (CI)Materials and Methods: This study was carried out at the Children’s Medical Center inTehran-Iran. In total, 661 samples were collected from 83 patients. The Candida CI wascalculated according to the descriptions of previous studies. The isolates were identified using polymerase chain reaction-based techniques. The Clinical and Laboratory Standard Institute protocol M60 was used to conduct the antifungal susceptibility test.Results: A colonization index greater than 0.5 was confirmed in 29 cases (58% ofpositive samples) with two children developing candidemia. Candida albicans (n=53,49.5%) was the most common Candida species in patients with CI > 0.5. Except foracute lymphoblastic leukemia, no risk factors were linked to a high index in colonizedchildren (P > 0.05). Twelve isolates (7.01%) were multi-azole resistant with high MICsagainst both isavuconazole and ravuconazole and seven strains (4.09%) wereechinocandins resistant.Conclusion: In pediatric intensive care units, patients are at risk of fungal infection,particularly candidemia. In this study, more than half of the children with positive yeastcultures had CI > 0.5, and 6.8% developed candidemia.

Background and Purpose: Scedosporium species are ubiquitous environmental fungi,which are considered emerging agents that trigger disease in humans and animals. Thepresent study aimed to determine Scedosporium dehoogii strain isolated from paddy field soil samples using semi-selective media and evaluate its antifungal susceptibility profile.Materials and Methods: Three paddy field soil samples were collected during aninvestigation for the isolation of Scedosporium species in Mazandaran province, Iran.Morphological and molecular analyses based on ITS-rDNA sequencing were performed. Furthermore, in vitro antifungal susceptibility testing for conventional drugs and novel imidazole (luliconazole) was performed based on Clinical and Laboratory Standards Institute M38-A3 guidelines.Results: In this study, S. dehoogii was isolated from the soil in paddy fields. Based onthe results, itraconazole and luliconazole showed the least and most antifungal activityagainst this isolate, respectively.Conclusion: Based on the findings, molecular identification was essential fordistinguishing the species of S. dehoogii. Remarkably, luliconazole showed potent activity against this strain.

Background and Aim: Denture stomatitis is the most prevalent oral mucosal lesion among denture wearers. Because there have been multiple reports of resistance of Candida species to antifungal drugs in the last two decades, if the antifungal properties of Achillea millefolium and Trachyspermum ammi are validated, these compounds may be a suitable adjuvant drug along with the use of common antifungal drugs. Therefore, the current study aimed to assess the antifungal activity of alcoholic extracts of Achillea millefolium and Trachyspermum ammi against Candida albicans isolated from denture stomatitis. Materials and Methods: Antifungal sensitivity of 50 isolates of C. albicans with the origin of denture stomatitis to the alcoholic extracts of Achillea millefolium and Trachyspermum ammi plants as well as the antifungal drugs miconazole and nystatin was determined by broth microdilution method and according to CLSI-M27S4 guidelines. The range of dilution for all compounds was 0.016-16 μg/ml. A concentration of compounds that showed at least 50% growth inhibition as compared to the positive control group was considered MIC (minimum growth inhibitory concentration). Statistical analysis was done using SPSS software and the significance level was considered as P

Since its first emergence in December 2019, due to its fast distribution throughout the world, SARS-COV-2 become a global concern. With the extremely increased number of hospitalized patients, this situation provided a potential basis for the transmission of nosocomial infections. Candida auris is a multidrug-resistant pathogen with improved transmission dynamics and resistance traits. During the worldwide spread of COVID-19, cases or outbreaks of C. auris colonization or infection have been reported. Resistance to antifungal drugs has been observed in the causative agents of the majority of such cases. The focus in this review is on COVID-19-associated C. auris infections (case studies/outbreaks) and the pandemic's potential effect on antifungal drug resistance.

Background and Purpose: This study aimed to evaluate the species distribution and susceptibility pattern of the strains isolated from Candida colonization in pediatric patients staying at pediatric intensive care unit (ICU) and infant ICU of Children’s Medical Center in Tehran, Iran.Materials and Methods: This study was conducted in the Children’s Medical Center in Tehran, Iran. In total, 440 samples from 56 patients with oral cavity, skin surrounded catheters, and ear, throat, nasal, and urine cultures were collected. All patients were evaluated in terms of Candida colonization on the admission day as well as the days 7, 14, and 28 according to the previous studies. CHROMagar Candida medium was applied for primary/multiple species identification and the isolates were identified by using polymerase chain reaction-based methods to the species-specific complex level. The antifungal susceptibility test was performed according to the Clinical and Laboratory Standards protocol published as M27-A3 and M60 documents.Results: In total, 136 yeast samples from 26 individuals (30.9%) out of 440 samples were considered colonization. The most prevalent species in IICU was C. albicans (27%,n=20) followed by C. krusei (24 %, n=18) and C. parapsilosis (16%, n=12). In PICU, the predominant species was C. krusei (40%, n=24) followed by C. parapsilosis (18%, n=11) and C. dubliniensis (16%, n=10). Among the 40 tested isolates from both units, fluconazole-resistant isolates (n=11, 8.15%) were determined according to the new breakpoints. In the case of echinocandins, 2 isolates, including C. albicans (n=1) and C. krusei (n=1) were resistant against both caspofungin and anidulafungin (totally 1.48%).Conclusion: In the present study, since C. krusei is intrinsically-resistance against fluconazole, emphasizing the importance of species-level identification of Candida isolates is outstanding. However, according to the antifungal susceptibility testingresults, only 7.2% of the strains were resistant to fluconazole. It would be beneficial tomonitor the ICU patients who are at high risk of invasive Candida infection.

Background and Purpose: Invasive mucormycosis is a rare mycosis that affects most cases of uncontrolled diabetes and has a high mortality rate. Patients with COVID-19 are at high risk of developing invasive mucormycosis due to the consumption of anti inflammatory drugs such as corticosteroids and dexamethasone. Rhizopus species followed by Rhizomucor spp. and Mucor spp. are the main common etiological agents of rhino-orbital mucormycosis. Therefore, this study aimed to present a case of mucormycosis due to Syncephalastrum racemosum in a diabetic patient with COVID-19 for the first time in Iran.Case report: A 73-year-old diabetic female was referred to Ayatollah Rouhani Hospital in Babol, Iran, with a confirmed COVID-19 diagnosis, based on positive RT-PCR and computed tomography of the lungs. She has received methylprednisolone due to severe lung complications. Nasal involvement and left orbital swelling were observed 20 days after the hospitalization. By sinus endoscopic surgery, debridement was done and histopathology indicated wide hyphae (without septa). The sequenced PCR products displayed Syncephalastrum racemosum. In the antifungal susceptibility test, amphotericin B showed good activity against S. racemosum and the patient survived with timely treatment.Conclusion: This is the first case report of rhino-orbital mucormycosis due to S. racemosum in COVID-19 patient; therefore, S. racemosum can be considered one of the etiological factors of rhino-orbital mucormycosis in COVID-19 cases.

Background and Purpose: Candida auris, as a new characterized pathogenic yeast,has attracted remarkable attention in the recent decade due to its rapid global emergence and multidrug resistance traits. This unique species is able to cause nosocomial outbreaks and tolerate adverse conditions; however, it has been mostly misidentified by conventional methods. Case report: This report aimed to describe the first fluconazole-resistant case of C.auris otitis in an immunocompetent patient in Iran. The isolate showed minimum inhibitory concentration of ≥ 32 μg/ml for fluconazole; however, the patient was treated with topical clotrimazole and miconazole with no recurrence. Conclusion: This was the second strain of C. auris isolated from otitis in Iran which was fluconazole-resistant, unlike the first Iranian isolate.

Recurrent vulvovaginal candidiasis (RVVC) is one of the most prevalent fungal infections in humans, especially in developing countries; however, it is underestimated and regarded as an easy-to-treat condition. RVVC may be caused by dysbiosis of the microbiome and other host-, pathogen-, and antifungal drug-related factors. Although multiple studies on host-related factors affecting the outcome have been conducted, such studies on Candida-derived factors and their association with RVVC are lacking. Thus, fluconazole-tolerant (FLZT) isolates may cause fluconazole therapeutic failure (FTF), but this concept has not been assessed in the context of Candida-associated vaginitis. Iran is among the countries with the highest burden of RVVC; however, comprehensive studies detailing the clinical and microbiological features of this complication are scarce. Therefore, we conducted a 1-year prospective study with the aim to determine the RVVC burden among women referred to a gynecology hospital in Tehran, the association of the previous exposure to clotrimazole and fluconazole with the emergence of FLZT and fluconazole-resistant (FLZR) Candida isolates, and the relevance of these phenotypes to FTF. The results indicated that about 53% of the patients (43/81) experienced RVVC. Candida albicans and C. glabrata constituted approximately 90% of the yeast isolates (72 patients). Except for one FLZT C. tropicalis isolate, FLZR and FLZT phenotypes were detected exclusively in patients with RVVC; among them, 27.9% (12/43) harbored FLZR strains. C. albicans constituted 81.2% of FLZR (13/16) and 100% of the FLZT (13/13) isolates, respectively, and both phenotypes were likely responsible for FTF, which was also observed among patients with RVVC infected with fluconazole-susceptible isolates. Thus, FTF could be due to host-, drug-, and pathogen-related characteristics. Our study indicates that FLZT and FLZR isolates may arise following the exposure to over-the-counter (OTC) topical azole (clotrimazole) and that both phenotypes can cause FTF. Therefore, the widespread use of OTC azoles can influence fluconazole therapeutic success, highlighting the necessity of controlling the use of weak topical antifungals among Iranian women.