High Incidence of Candidemia in Critically Ill COVID-19 Patients Supported by Veno-Venous Extracorporeal Membrane Oxygenation: A Retrospective Study

Abstract

Background: The incidence of candidemia in severe COVID-19 patients (0.8–14%) is two- to ten-fold higher than in non-COVID-19 patients. Methods: This retrospective analysis aimed to analyse the incidence of bloodstream infections (BSI) due to Candida in a cohort of COVID-19 patients supported with ECMO. Results: Among 138 intubated and ventilated patients hospitalized for ≥10 days in the intensive care unit of a teaching hospital, 45 (32.6%) patients received ECMO support, while 93 patients (67.4%) did not meet ECMO criteria and were considered the control group. In the ECMO group, 16 episodes of candidaemia were observed, while only 13 in patients of the control group (36.0% vs. 14.0%, p-value 0.004). It was confirmed at the survival analysis (SHR: 2.86, 95% CI: 1.39–5.88) and at the multivariable analyses (aSHR: 3.91, 95% CI: 1.73–8.86). A higher candida score seemed to increase the hazard for candidemia occurrence (aSHR: 3.04, 95% CI: 2.09–4.42), while vasopressor therapy was negatively associated with the outcome (aSHR: 0.15, 95% CI: 0.05–0.43). Conclusions: This study confirms that the incidence of candidemia was significantly higher in critically ill COVID-19 patients supported with VV-ECMO than in critically ill COVID patients who did not meet criteria for VV-ECMO.

COVID-19 Is an Independent Risk Factor for Detrimental Invasive Fungal Disease in Patients on Veno-Venous Extracorporeal Membrane Oxygenation: A Retrospective Study

“…Furthermore, in non-COVID-19 patients on ECMO in our institution, the incidence of candidemia was only slightly higher than in the general ICU population (4.8% versus 3.3%) [30]. Of note, we observed a much lower incidence of candidemia than that reported by Alessandri et al (9.32% versus 35.6%) [14].…”

“…COVID-19 might also induce the breakdown of mucosal barriers, such as in the lung or intestines. It is speculative whether this explains the higher incidence of candidemia in COVID-19 patients on ECMO, compared to COVID-19 patients not on ECMO, as reported by Alessandri et al [14]. We believe that it is not ECMO itself that is causing candidemia, as in our multivariable regression analysis, time on ECMO before IFD was not associated with IFD.…”

“…Recent studies have reported a survival rate of 27-32% for COVID-19 patients on ECMO in Germany [23,24]. In a current Italian study, the mortality rate of COVID-19 patients on ECMO even exceeded 80% [14]. For greater Paris, France, 90-day-survival was reported with 46% [25,26].…”

“…Coronavirus disease (COVID- 19) is associated with candidemia and pulmonary aspergillosis in hospitalized patients [10][11][12]. Recent studies have also described a high incidence of aspergillosis and candidemia in patients with COVID-19 (COVID-19 + patients) on ECMO [13,14]. We hypothesize that COVID-19 is an independent risk factor for IFD in patients on ECMO, which has not been investigated so far.…”

Drug–Drug Interactions in Patients with Acute Respiratory Distress Syndrome

“…We assumed that patients receiving ECMO treatment may require more analgosedation, a more intense anticoagulation, and may be sicker overall. For instance, studies reported higher infection rates among patients who were ECMO-treated compared to patients who were non-ECMO-treated [ 32 , 33 , 34 ]. Moreover, we observed a longer treatment duration in the ECMO subgroup.…”