Volume 24, Issue 3 (August & September 2021)                   J Arak Uni Med Sci 2021, 24(3): 348-359 | Back to browse issues page

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Rezaei E, Didehdar M, Mirhoseini S H. Study of Fungal Contamination Intensive Care Units of Arak Educational Hospitals and Determining Drug Sensitivity Profiles of Isolated Species. J Arak Uni Med Sci 2021; 24 (3) :348-359
URL: http://jams.arakmu.ac.ir/article-1-6766-en.html
1- Student Research Committee, Arak University of Medical Sciences, Arak, Iran.
2- Department of Medical Parasitology and Mycology, School of Medicine, Arak University of Medical Sciences, Arak, Iran.
3- Department of Environmental Health, School of Health, Arak University of Medical Sciences, Arak, Iran. , hmirhossaini@gmail.com
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1. Introduction
nvasive fungal infections are a significant concern in high-risk hospital wards. In most cases, these infections are caused by opportunistic fungi in immunocompromised patients and other health disorders, which do not cause infections, especially invasive infections, in patients with healthy immunity [1]. Fungal spores are also among the bio-aerosols found everywhere. Their widespread spread can cause various forms of the disease, especially in people with weakened immune systems and hospitalization. Fungi have high adaptability to different environmental conditions. However, fungal contamination in indoor environments depends on several factors such as humidity, ventilation, temperature, organic matter in building materials, fungal load in the exterior of the building, and construction activities. This study investigated the frequency of opportunistic fungi, especially Candida, Aspergillus, Zygomycetes, and Fusariums in the air and surfaces of special wards of Arak educational hospitals and determined the drug susceptibility isolated species to azoles, amphotericin B, and caspofungin. 
2. Materials and Methods
This descriptive cross-sectional study was performed for one year in Intensive Care Units (ICU) of Arak University of Medical Sciences educational hospitals. A total of 63 samples of air and 63 samples surfaces were collected. Active air sampling was performed using Anderson single-stage sampler (SKC Co., UK) with a flow rate of 28.3 for 5 minutes on Sabrodextrose agar (Merck, Germany) containing chloramphenicol [17]. The sampling device was placed about 1.5 meters above the ground and maintained one meter from the wall and obstacles. Simultaneously with air sampling, the sampling of surfaces of each ward was randomly taken from different characters of each word using a sterile wet swab and cultured linearly in sabrodextrose agar medium containing chloramphenicol. Samples were stored at 28°C for 7-10 days and monitored daily for colony formation. Initial identification of fungal colonies was performed using their macroscopic and microscopic features. The susceptibility testing of the studied samples of antifungal drugs was performed according to the CLSI-M38A2 standard method.
3. Results
From the total number of samples, 18 fungal species were isolated, including 8 cases of Aspergillus niger, 4 instances of Aspergillus flavus, 2 cases of Aspergillus fumigatus, 2 cases of Rhizopus species, 1 case of Mucor species, and 1 case of Fusarium species. Table 1 shows the pathogenic fungal species isolated from the air and surface samples at the different wards studied. 

In drug sensitivity, one case of the relative sensitivity of Aspergillus fumigatus to itraconazole, one case of the relative sensitivity of Aspergillus niger to ketoconazole, and one case of Aspergillus niger resistance to itraconazole were observed.
4. Discussion and Conclusion
In the present study, pathogenic organisms isolated from 102 samples of high-risk wards of Arak educational hospitals included: Aspergillus niger 8 cases, Aspergillus flavus 4 cases, Aspergillus fumigatus 2 cases, Mucor 1 case, Raisopus 2 cases, Fusarium 1 case. Interestingly, no candidate yeast was isolated in this study. Considering that Candida is one of the fungi of the normal flora of patients [4], the probable cause of a negative result for Candida may be the proper observance of health tips by the medical staff of the wards. 
In a study conducted by Nasrollahi et al. (2017) in Tonekabon, focusing on Aspergillus species in ICUs, out of 160 isolated Aspergillus specimens, 5 Aspergillus flavus, 3 Aspergillus sidoyi, 2 Aspergillus orizea, and 1 Aspergillus fumigatus [19]. The study investigated drug resistance to available drugs such as ketoconazole, itraconazole, vriconazole, caspofangin and amphotericin B. The detected isolates included Aspergillus (Niger, Flavus, and Fumigatus), Rhizopus, Mucor, and Fusarium species. In this study, Aspergillus flavus, Mucor, Rhizopus, and Fusarium species were sensitive to all studied drugs. 
Aspergillus fumigatus was semi-sensitive to itraconazole in one case, and Aspergillus niger was semi-sensitive to ketoconazole and resistant to itraconazole in one case. The general view of drug resistance of Aspergillus species obtained from this study are similar to the results of the survey of Hojjatinia et al. (2016) [22], Denning et al. (2002) [23], Araujo et al. (2008) [24], Shi ( 2010) [25] and the study of Tang et al. (2016) [26] and therefore voriconazole and caspofungin can be named as the most effective first-line drugs in the treatment of invasive Aspergillosis. Therefore, based on the results, the new drugs mentioned in the instructions, including voriconazole and caspofungin (the main drugs for the treatment of invasive aspergillosis) and amphotericin B (the primary drug for the treatment of invasive mucormycosis and fusariosis), are effective on all detected isolates in the present study. 

Ethical Considerations
Compliance with ethical guidelines

The Research Ethics Committee of Arak University of Medical Sciences approved this study (Code: IR.ARAKMU.REC.1395.315).

This study was extracted from a research proposal approved by Arak University of Medical Sciences (Code: 2679). 

Authors' contributions
All authors had equal attribution in preparing the paper.

Conflicts of interest
The authors declare no conflict of interest.

The authors would like to thank the Vice-Chancellor for Research and the staff of Arak educational hospitals for their valuable spiritual and financial support.

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Type of Study: Original Atricle | Subject: Basic Sciences
Received: 2021/01/26 | Accepted: 2021/05/11

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