Fungal Infections in COVID-19 Intensive Care Patients

Abstract

Opportunistic fungal infections increase morbidity and mortality in COVID-19 patients monitored in intensive care units (ICU). As patients’ hospitalization days in the ICU and intubation period increase, opportunistic infections also increase, which prolongs hospital stay days and elevates costs. The study aimed to describe the profile of fungal infections and identify the risk factors associated with mortality in COVID-19 intensive care patients. The records of 627 patients hospitalized in ICU with the diagnosis of COVID-19 were investigated from electronic health records and hospitalization files. The demographic characteristics (age, gender), the number of ICU hospitalization days and mortality rates, APACHE II scores, accompanying diseases, antibiotic-steroid treatments taken during hospitalization, and microbiological results (blood, urine, tracheal aspirate samples) of the patients were recorded. Opportunistic fungal infection was detected in 32 patients (5.10%) of 627 patients monitored in ICU with a COVID-19 diagnosis. The average APACHE II score of the patients was 28 ± 6. While 25 of the patients (78.12%) died, seven (21.87%) were discharged from the ICU. Candida parapsilosis (43.7%) was the opportunistic fungal agent isolated from most blood samples taken from COVID-19 positive patients. The mortality rate of COVID-19 positive patients with candidemia was 80%. While two out of the three patients (66.6%) for whom fungi were grown from their tracheal aspirate died, one patient (33.3%) was transferred to the ward. Opportunistic fungal infections increase the mortality rate of COVID-19-positive patients. In addition to the risk factors that we cannot change, invasive procedures should be avoided, constant blood sugar regulation should be applied, and unnecessary antibiotics use should be avoided.

Mortality in critically ill COVID-19 patients with fungal infections: a comprehensive systematic review and meta-analysis

“…All of the papers were observational in design (n=38), of which 10 were prospective [15][16][17]19,24,36,40,41,44,48] and 26 retrospective studies [18,[20][21][22][23][25][26][27][28][29][30][31][32][33][34][35][37][38][39]42,43]. Among them, 8 studies were classified as case-series [18,21,22,27,37,40,45,47]. The 2 remaining studies were both prospective and retrospective in design [50,52].…”

“…By implementing NOS, we assessed 30 analytical studies (the remaining 8 studies were descriptive in design). Overall, we identified 12 studies of "good" quality [15,22,27,28,36,41,45,46,48,[50][51][52] and 18 studies of "poor" quality [16][17][18][19][20][21][23][24][25][26][29][30][31][32][33][34][35][37][38][39][40][42][43][44]47,49]. The majority of studies were deemed to be lacking in terms of "Comparability" criterion, as the aforementioned 26 studies did not control for any confounding factors (Supplementary Table 2).…”

“…The number of patients who developed any fungal infection over the course of COVID-19 disease was 1182 and accounted for 6.7% of all patients. The mean or median age of patients with fungal infection in 19 studies was above 65 years [15,16,19,21,23,26,27,29,31,33,34,[37][38][39][40][41][45][46][47] whereas in the remaining 15, below 65 years [13,14,17,18,20,22,24,30,32,35,36,42,43,48,49]. Information regarding age was absent in four studies [23,28,44,50].…”

“…was 32 (of which 20 focused only on Aspergillus spp. [13,15,17,19,[21][22][23]30,31,[34][35][36][40][41][42][43]46,47,49,50] and 12 focused on various fungal infections [14,18,20,25,[27][28][29]37,38,45,48]). All Aspergillus spp.…”

Root Causes of Fungal Coinfections in COVID-19 Infected Patients

“…As antibiotic use may disrupt the balance between oral bacterial and yeast populations, it can create an environment that permits candida overgrowth and infection [ 91 ]. Clinicians in Turkey observed that COVID-19 patients who were receiving broad-spectrum antibiotics were at an increased risk for developing candidemia [ 92 ]. In COVID-19 treatment guidelines, the World Health Organization recommends against the use of broad-spectrum antibiotics unless there is a clinical suspicion of bacterial infection [ 93 ].…”