Tehran University of Medical Sciences Iranian Journal of Microbiology 2008-3289 16 6 2024 12 08 792 802 Parviz Hassanpour Department of Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Seyed Jamal Hashemi Department of Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran; Food Microbiology Research Center, Tehran University of Medical Sciences, Tehran, Iran Sanam Nami Department of Parasitology and Mycology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran Roshanak Daie Ghazvini Department of Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Behrouz Naghili Hokmabadi Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran Abbas Rahimi Foroushani Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Kazem Ahmadikia Department of Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Zahra Ramezanalipour Department of Parasitology and Mycology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran Saeid Firouzi Abriz Department of Parasitology and Mycology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran 2024 05 28 2024 11 10 Background and Objectives: Airway fungal infection is a severe clinical problem, especially in patients with compromised immune functions. Here, we examined the distribution and antifungal susceptibility profiles of fungal agents isolated from respiratory tract of symptomatic patients hospitalized in pulmonary units. Materials and Methods: This descriptive cross-sectional study took place from 2023 to 2024, involving 360 patients. Bronchoalveolar lavage (BAL) or sputum specimens were collected and analyzed using mycological and molecular methods for this study. Antifungal susceptibility testing (AFST) was carried out using the broth micro dilution method. Results: Of a total of 360 respiratory specimens, 114 (31.6%) were positive. The male-to-female ratio was 63:51 (1.3%). Candida albicans and Aspergillus flavus were the most common yeast and mold species. Chronic obstructive pulmonary disease (COPD) had the highest rate of colonization with fungal agents (47/114, 41%). The isolates associated with COPD in this study included Aspergillus species (4/12, 3.5%), Candida species (41/96, 36%), and other fungal species (2/6, 1.5%). Coughing (87%) was the predominant symptom, and malignancy (52%) was the predominant comorbidity factor. The result of AFST for antifungal agents showed that 9 (22.5%) Candida isolates were resistant, and the highest rate of resistance was related to voriconazole agent (5/9, 55.5%). Resistance to antifungal agents was not observed among Aspergillus isolates. Conclusion: This study showed a significant relationship between the frequency of Aspergillus and Candida species in patients with underlying lung diseases. In addition, voriconazole was more effective than itraconazole, especially against Aspergillus flavus. https://ijm.tums.ac.ir/index.php/ijm/article/view/4825 https://ijm.tums.ac.ir/index.php/ijm/article/download/4825/1731