Characteristics of Candidemia in COVID-19 Patients; Increased Incidence, Earlier Occurrence, and Higher Mortality Rates Compared to Non-COVID-19 Patients

Link to article at PubMed

Mycoses. 2021 Jun 4. doi: 10.1111/myc.13332. Online ahead of print.


BACKGROUND: Severe COVID-19 patients in ICU are at high risk for candidemia due to exposure to multiple risk factors for candidemia.

OBJECTIVES: We aimed to compare the incidence of candidemia in ICU patients with and without COVID-19, and to investigate epidemiologic and clinical characteristics of candidemia patients and risk factors for mortality in candidemia patients.

PATIENTS/METHODS: This retrospective study was conducted in patients followed in the ICUs of Ankara City Hospital for two years, divided into pre-pandemic and pandemic periods. The incidence (event per 1000 patient-days) and epidemiology of candidemia, clinical and laboratory characteristics of patients were compared in COVID-19 and non-COVID-19 groups.

RESULTS: Candidemia incidence was higher in the COVID-19 group (2.16, 95% CI 1.77-2.60) than the non-COVID-19 group (1.06, 95% CI 0.89-0.125) (P < 0.001). A total of 236 candidemia episodes (105 in COVID-19 patients and 131 in non-COVID-19 patients) were detected during the study periods. COVID-19 cases had a higher rate of corticosteroid use (63.8% vs 9.9%, P < 0.001). Epidemiology of candidemia and antifungal susceptibility were similar. Candidemia developed 2 weeks earlier in COVID-19 groups and resulted in higher mortality (92.5% vs 79.4%, P 0.005). One-third of candidemia patients died before receiving any antifungal treatment, this rate was higher in the COVID-19 group. In multivariate logistic regression analysis, corticosteroid use, presence of sepsis and age older than 65 years were independent risk factors for mortality in candidemia patients.

CONCLUSIONS: Candidemia with high mortality is a more serious problem for COVID-19 patients due to its increased incidence, earlier occurrence, and a higher rate of mortality.

PMID:34085319 | DOI:10.1111/myc.13332

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