Colonization and azole resistance of oropharyngeal Candida fungi in intensive care patients with COVID-19

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Abstract

Patients with COVID-19 are susceptible to developing oropharyngeal candidiasis and invasive candidiasis. Invasive fungal infections can complicate the clinical course of COVID-19 and are associated with a substantially increased mortality. An important reason for the successful treatment of candidiasis is to determine the sensitivity of clinical fungal isolates to antimycotics. A microbiological study of oropharyngeal swabs was performed in 54 patients aged 33 to 94 years (mean age 67.4 years) with severe and extremely severe COVID-19, who were treated in the intensive care unit at the height of clinical manifestations. Most patients (95%) had comorbidities: hypertension (68.5%), diabetes mellitus (24%), coronary artery disease (22.2%), chronic heart failure (38.9%), obesity (23.8%), cardiac arrhythmias (20.4%), chronic cerebral ischemia (56.1%), varicose veins of the lower extremities (5.5%), chronic kidney disease (20.4%), liver cirrhosis (5.5%), HIV infection (5.5%). A comparative analysis of oropharyngeal microbial biocenosis showed differences in the frequency of occurrence of opportunistic microbial species, as well as in the number of members in microbial associations. Polyspecific fungal-bacterial associations were more common and dominated polyspecific bacterial associations. According to the results, a high frequency of oropharyngeal colonization in patients with severe COVID-19 by strains of fungi of the genus Candida was established. The vast majority of strains of fungi of the genus Candida (85.2%) were resistant to antimycotics of the azole group. A high frequency (85.2%) of oropharyngeal colonization in resuscitation patients with azole-resistant strains of fungi of the genus Candida was revealed. C. albicans dominated among Candida. C. albicans was isolated in 37 (68.5%) patients, C. pararapsilosis — in 6 (11.1%), C. tropicalis — in 3 (5.5%), C. krusei — in 2 (3.7%)%), C. kefyr — in 1 (1.9%), C. glabrata — in 1 (1.9%) patient. In 11 (20.4%) patients, associations of C. albicans and other Candida species were identified. The level of fungi in the material was etiologically significant (> 104–105 CFU/tamp.) in 80% of patients. The vast majority of strains (more than 70%) were resistant to fluconazole and voriconazole, which should be taken into account when prescribing candidiasis therapy in patients with COVID-19. The MIC for fluconazole against C. albicans strains was > 1024 µg/ml for 4 isolates, 512 µg/ml for 7 isolates, and 128 µg/ml for 15 isolates. The maximum MIC values for voriconazole against C. albicans was 256 µg/ml.

About the authors

Svetlana A. Lisovskaya

Kazan Scientifc Research Institute of Epidemiology and Microbiology; Kazan State Medical University; Kazan Federal University

Author for correspondence.
Email: S_Lisovskaya@mail.ru

PhD (Biology), Leading Researcher, Laboratory of Mycology; Associate Professor, Department of Microbiology; Leading Researcher, Biologically Active Terpenoids Laboratory

Russian Federation, Kazan; Kazan; Kazan

Guzel Sh. Isaeva

Kazan Scientifc Research Institute of Epidemiology and Microbiology; Kazan State Medical University

Email: S_Lisovskaya@mail.ru

DSc (Medicine), Professor, Deputy Director for Innovation Development; Head of the Department of Microbiology

Russian Federation, Kazan; Kazan

Irina V. Nikolaeva

Kazan State Medical University

Email: S_Lisovskaya@mail.ru

DSc (Medicine), Professor, Head of the Department of Infectious Diseases

Russian Federation, Kazan

Sophia E. Guseva

Republican Clinical Infectious Diseases Hospital (RCIDH)

Email: S_Lisovskaya@mail.ru

Infectious Diseases Physician

Russian Federation, Kazan

Lilia R. Gainatullina

Republican Clinical Infectious Diseases Hospital (RCIDH)

Email: S_Lisovskaya@mail.ru

Infectious Diseases Physician, Head of the Department

Russian Federation, Kazan

Nikita S. Chumarev

Kazan State Medical University

Email: S_Lisovskaya@mail.ru

Assistant Professor, Department of Microbiology

Russian Federation, Kazan

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Supplementary files

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2. Figure 1. Species composition of oropharyngeal microbial landscape in patients with COVID-19

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3. Figure 2. The frequency of oropharyngeal isolation of various types of Candida fungi in patients with severe and extremely severe COVID-19

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4. Figure 3. Age-related frequency of occurrence of bacterial and bacterial-fungal associations isolated from patients with severe and extremely severe COVID-19

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Copyright (c) 2023 Lisovskaya S.A., Isaeva G.S., Nikolaeva I.V., Guseva S.E., Gainatullina L.R., Chumarev N.S.

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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