Nosocomial Fungal Infections in South of Iran: Epidemiology, Risk Factors, and Antifungal Susceptibility

Abstract

Background: Hospital-acquired fungal infections pose a serious risk to patients in healthcare facilities because of their high morbidity and mortality rates. In recent years, the incidence of nosocomial fungal infections has increased. Objectives: This study aimed to determine the incidence of hospital-acquired fungal infections and evaluate associated risk factors, causative organisms, and sites of infection. Methods: In this 10-month cross-sectional surveillance study, 12,941 hospitalized patients were screened. Patients without evidence of infection at admission who were hospitalized for ≥ 7 days were enrolled. Suspected fungal infections were assessed using clinical, radiological, and laboratory findings and classified according to the European Organization for Research and Treatment of Cancer and the Mycoses Study Group Education and Research Consortium (EORTC-MSGERC) criteria. Clinical specimens were examined by direct microscopy, culture, and real-time PCR, and antifungal susceptibility testing was performed according to Clinical and Laboratory Standards Institute guidelines. Results: During the study period, 12,941 patients were admitted to the hospital; 3,890 had no signs of infectious disease on admission and were therefore included in this study. According to global standards, 153 patients developed clinical symptoms of a fungal infection during hospitalization. Proven and probable infections were diagnosed in 40 patients (1.03%, 40/3,890). Candida species colonization was identified in 41 infected patients (41/153, 26.8%). The isolated species included Aspergillus flavus, Aspergillus fumigatus, Candida albicans, Candida glabrata, and Mucorales. Conclusions: Various fungal species with different antifungal susceptibility patterns were identified among isolates from patients. Common risk factors for hospital-acquired fungal infections included immunosuppressive conditions such as liver transplantation, blood disorders, and prolonged intensive care unit stays.