Prevalence of Fungal Drug Resistance in COVID-19 Infection: a Global Meta-analysis

Adrina Habibzadeh; Kamran B Lankarani; Mojtaba Farjam; Maryam Akbari; Seyyed Mohammad Amin Kashani; Zeinab Karimimoghadam; Kan Wang; Mohammad Hossein Imanieh; Reza Tabrizi; Fariba Ahmadizar

doi:10.1007/s12281-022-00439-9

Prevalence of Fungal Drug Resistance in COVID-19 Infection: a Global Meta-analysis

Curr Fungal Infect Rep. 2022;16(4):154-164. doi: 10.1007/s12281-022-00439-9. Epub 2022 Aug 15.

Authors

Affiliations

¹ Student Research Committee, Fasa University of Medical Sciences, Fasa, Iran.
² USERN Office, Fasa University of Medical Sciences, Fasa, Iran.
³ Health Policy Research Center, Institute of Health, Shiraz University of Medical Sciences, Shiraz, Iran.
⁴ Noncommunicable Diseases Research Center, Fasa University of Medical Sciences, Fasa, Iran.
⁵ Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
⁶ Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
⁷ Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
⁸ Clinical Research Development Unit of Vali Asr Hospital, Fasa University of Medical Sciences, Fasa, Iran.
⁹ Department of Data Science and Biostatistics, University Medical Center Utrecht, Utrecht, The Netherlands.

Abstract

Purpose: Secondary bacterial or fungal infections are one of the most important medical complications among patients with Coronavirus Disease 2019 (COVID-19). The emergence of multidrug-resistant (MDR) candida can cause many problems such as treatment failure, adverse clinical outcomes, and even disease outbreaks. This systematic review and meta-analysis aims to investigate the prevalence and outcomes of fungal drug-resistant in COVID-19 patients.

Methods: PubMed, Embase, Scopus, Cochrane Library, and Web of Science databases were searched for peer reviewed-articles published in English up to May 20, 2021. Heterogeneity across studies was evaluated using Cochrane's Q test and the I² index. The pooled point prevalence and their corresponding 95% confidence intervals (CIs) were considered to estimate the prevalence of fungal drug resistance infection in COVID-19 patients.

Results: Eight eligible articles were included in our meta-analysis. The number of COVID-19 patients with fungal co-infection varied from 5 to 35 among selected studies. The overall pooled prevalence of fungal drug resistance among patients with co-infections of fungal and COVID-19 was 69% (95% CI: 37%, 94%) by using a random-effects model. In terms of specific species, the pooled meta-analysis for Candida Auris was estimated to be 100% (95%CI: 98%, 100%; I² = 0%), for Multi-Candida 59% (95%CI: 38%, 79%; I² = 12.5%), and for Aspergillus 15% (95%CI: 0%, 42%; I² = 0%).

Conclusion: Our study shows the high prevalence of fungal drug resistance in COVID-19 patients and emphasizes the need to strengthen antimicrobial stewardship programs, close monitoring for treatment failure, and the emergence of resistance upon treatment.

Supplementary information: The online version contains supplementary material available at 10.1007/s12281-022-00439-9.

Keywords: COVID-19; Candidiasis; Drug Resistance; Fungi; Meta-analysis.

© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2022, Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Publication types

Review