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Candiduria is common among patients admitted to intensive care units (ICUs); however, clinical and microbiological data are limited, which accounts for non-compliance with international guidelines, including over treatment of asymptomatic candiduria that promotes antifungal resistance. This prospective study included adult patients admitted to ICUs of five referral hospitals in Shiraz, Iran, during 2016–2018. Species were identified by MALDI-TOF MS, and antifungal susceptibility was assessed according to CLSI M27-A3/S4. Among 2086 patients, 162 and 293 developed candiduria and bacteriuria, respectively. In total, 174 yeast isolates were collected; 88.5% were Candida albicans (91/174; 52.2%), C. glabrata (38/174; 21.8%), and C. tropicalis (25/174; 14.3%). Antifungal resistance was rare; only two isolates (one C. tropicalis and one C. krusei) were fluconazole resistant. Symptomatic candiduria was noted in 31.4% of patients (51/162); only 37% (19/51) of them were treated and 36.82% (7/19) showed fluconazole therapeutic failure. Two symptomatic patients developed candidemia shortly after candiduria. Among asymptomatic patients, 31.5% (35/111) were overtreated with fluconazole. The mortality rate was 25.3% (41/162); it did not differ between symptomatic and asymptomatic patients. Our results indicate that deviation from standard-of-care treatment for candiduria is a matter of concern given the high rate of fluconazole therapeutic failure among patients with symptomatic candiduria. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Candida tropicalis is one of the major candidaemia agents, associated with the highest mortality rates among Candida species, and developing resistance to azoles. Little is known about the molecular mechanisms of azole resistance, genotypic diversity, and the clinical background of C. tropicalis infections. Consequently, this study was designed to address those questions. Sixty-four C. tropicalis bloodstream isolates from 62 patients from three cities in Iran (2014–2019) were analyzed. Strain identification, antifungal susceptibility testing, and genotypic diversity analysis were performed by MALDI-TOF MS, CLSI-M27 A3/S4 protocol, and amplified fragment length polymorphism (AFLP) fingerprinting, respectively. Genes related to drug resistance (ERG11, MRR1, TAC1, UPC2 , and FKS1 hotspot9s) were sequenced. The overall mortality rate was 59.6% (37/62). Strains were resistant to micafungin [minimum inhibitory concentration (MIC) ≥1 μg/ml, 2/64], itraconazole (MIC > 0.5 μg/ml, 2/64), fluconazole (FLZ; MIC ≥ 8 μg/ml, 4/64), and voriconazole (MIC ≥ 1 μg/ml, 7/64). Pan-azole and FLZ + VRZ resistance were observed in one and two isolates, respectively, while none of the patients were exposed to azoles. MRR1 (T255P, 647S), TAC1 (N164I, R47Q), and UPC2 (T241A, Q340H, T381S) mutations were exclusively identified in FLZ-resistant isolates. AFLP fingerprinting revealed five major and seven minor genotypes; genotype G4 was predominant in all centers. The increasing number of FLZ-R C. tropicalis blood isolates and acquiring FLZ-R in FLZ-naive patients limit the efficiency of FLZ, especially in developing countries. The high mortality rate warrants reaching a consensus regarding the nosocomial mode of C. tropicalis transmission. [ABSTRACT FROM AUTHOR]

Candida species are considered the primary causative agents of denture stomatitis, but their role in colonization and disease in denture wearers remains undefined. In this study, we investigated risk factors associated with progression to Candida-related denture stomatitis in patients using complete dentures, and we genetically identified Candida isolates associated with disease and colonization. We recruited 114 retirement home residents for this study, from whom oral mucosa samples were collected and cultured following oral cavity exams. Morphologic analysis was used to identify potential yeast-positive cultures, which were then characterized further by RFLP analysis. C. albicans was the most frequently recovered species (61; 41.5%), followed by C. glabrata (27; 18.4%), and C. tropicalis (19; 12.9%). In addition, 16 isolates (10.9%) of C. dubliniensis were recovered, which was the first identification of this species in clinical samples from Iran. This study demonstrated a significant association between the duration of denture wear and oral candidiasis. Furthermore, we noted a high prevalence of C. dubliniensis in complete denture wearers. [ABSTRACT FROM AUTHOR]

Fungal infections are serious complications after solid organ transplantation, with high mortality and morbidity. Given the importance of the local epidemiological data and also extensive prophylactic regimens in solid organ transplant (SOT) recipients, this study aimed to investigate the clinical characteristics and resistance patterns of yeast isolates in SOT recipients at a main referral transplant center in Iran. Of the 275 recipients enrolled, 22 (8%) had at least one positive yeast culture at a median of 5 days after transplantation. Bacterial infection and reoperation were significantly associated with colonization or infection caused by yeast species (P = .001). Moreover, mortality and length of ICU/hospital stay were significantly higher in patients with positive yeast cultures (P < .05). The most frequent species isolated was Candida albicans (50%), followed by C. glabrata (22.7%). Of species with definite breakpoints, the fluconazole-resistant rate was 23%. Caspofungin and amphotericin B showed potent activity against all isolates. Regarding the high risk of fungal infections, awareness of local epidemiological trends and resistance patterns can help improve outcomes in SOT recipients., (© The Author(s) 2024. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology.)