SARS-CoV-2 infection and fungal infectionsCandida and Aspergillus spp. were identified as the most common causes of invasive fungal infections in COVID-19 patients (Ezeokoli and Pohl, 2020). The mortality rate of invasive Candida infections was twice as high in COVID-19 patients as in non-COVID-19 patients (Seagle et al., 2022). Therefore, prevention of the complications of fungal infections in COVID-19 is a crucial issue with implications for prognosis.
Risk factors for COVID-19-associated candidiasisYazdanpanah S et al. analyzed risk factors for COVID-19-associated candidiasis (Yazdanpanah et al., 2023). They used multiple logistic regression to show that heart failure, bacterial co-infection, and empiric antifungal use were significant risk factors for Candida co-infection in hospitalized COVID-19 patients (Yazdanpanah et al., 2023). In their study, azoles were used for empirical antifungal treatment, and in some cases, azoles were used in combination with the echinocandin antifungal agent caspofungin. The antifungal effects seem to differ among these drugs. While some Candida strains were resistant to azoles, caspofungin was effective against all isolated strains in that study (Yazdanpanah et al., 2023). In addition, the study found higher odds of in-hospital mortality in Candida culture-positive patients (RR: 2.18, 95% CI: 0.9, 5.2) (Yazdanpanah et al., 2023), but no subgroup analysis classified by empiric therapy was performed. We believe that this study should elucidate whether empirical caspofungin treatment can improve prognosis in a cohort of COVID-19 patients with risk factors for fungal infection complications.