P156 Oral Candidiasis among inpatients with COVID-19 in the North of Iran

Abstract

 Poster session 2, September 22, 2022, 12:30 PM - 1:30 PMObjectivesWe aimed to characterize oral candidiasis epidemiology, species distribution, and antifungal susceptibility profiles among COVID-19 patients.MethodsThis observational cross-sectional study enrolled patients ˃18 years old with confirmed oral candidiasis admitted at Razi teaching hospital (a reference infectious disease center in Mazandaran Province). Oral samples from patients with suspected oral candidiasis infection were collected and were confirmed for oral candidiasis by microscopic examination and fungal culture. Fungal isolates were identified using Multiplex polymerase chain reaction (PCR) and PCR-restriction fragment length polymorphism. In vitro susceptibility testing for amphotericin B, fluconazole, voriconazole, and micafungin of all identified isolates was performed using broth microdilution according to the Clinical and Laboratory Standards Institute (CLSI) broth microdilution guideline (M27-A3 and M60) standard.ResultsAmong 4133 COVID-19 admitted patients during a year in Razi hospital, 120 patients had confirmed oral candidiasis. Totally 172 Candida isolates causing oral candidiasis isolated from these patients were identified. Most patients were infected with a single Candida species; however, it is notable that mixed Candida species caused oral candidiasis in 46 patients. Candida albicans (60.46%) was the most common species. Among non-albicans Candida species, C. glabrata (17.44%) was the most isolates, followed by C. tropicalis (11.62%), C. kefyr (7.55%), and C. krusei (2.9%). Although non-albicans Candida species, including C. glabrata and C. krusei demonstrated high minimum inhibitory concentration (MIC) against azole drugs, in terms of MIC90 values, all tested drugs exhibited superior activity against C. albicans. In terms of MIC Geometric mean, amphotericin B and micafungin were more potent than all comparator drugs.ConclusionsOur study described the high incidence of oral candidiasis caused by non-albicans Candida species in COVID-19 patients; most of them, including C. glabrata and C. krusei exhibits intrinsic decreased susceptibility to the azole class of antifungals. Further studies should design an appropriate prophylaxis program to prevent oral candidiasis in COVID-19 patients.