Incidence of Candidemia Is Higher in COVID-19 versus Non-COVID-19 Patients, but Not Driven by Intrahospital Transmission

Abstract

There is scarce information on the actual incidence of candidemia in COVID-19 patients. In addition, comparative studies of candidemia episodes in COVID-19 and non-COVID-19 patients are heterogeneous. Here, we assessed the real incidence, epidemiology, and etiology of candidemia in COVID-19 patients, and compared them with those without COVID-19 (2020 vs. 2019 and 2020, respectively). We also genotyped all C. albicans, C. parapsilosis, and C. tropicalis isolates (n = 88), causing candidemia in both groups, providing for the first time a genotypic characterization of isolates gathered in patients with either COVID-19 or non-COVID-19. Incidence of candidemia was higher in patients with COVID-19 than non-COVID-19 (4.73 vs. 0.85 per 1000 admissions; 3.22 vs. 1.14 per 10,000 days of stay). No substantial intergroup differences were found, including mortality. Genotyping proved the presence of a low number of patients involved in clusters, allowing us to rule out rampant patient-to-patient Candida transmission. The four patients, involved in two clusters, had catheter-related candidemia diagnosed in the first COVID-19 wave, which demonstrates breaches in catheter management policies occurring in such an overwhelming situation. In conclusion, the incidence of candidemia in patients with COVID-19 is significantly higher than in those without COVID-19. However, genotyping shows that this increase is not due to uncontrolled intrahospital transmission.

Occurrence of Candidemia in Patients with COVID-19 Admitted to Five ICUs in France

“…Contrary to a previous study by Machado et al, only one isolate was found that was resistant to antifungal drugs [4]. Similarly, Candida auris, whose first described case occurred in our institution [20], was not found, although its incidence is high in some studies [21].…”

“…Conflicting data exist regarding the incidence of candidemia among patients with severe COVID-19 [ 1 , 2 , 3 , 4 , 5 ]. In this study, we analyzed the occurrence of invasive candidiasis in a cohort of 264 patients during an 11-month period.…”

“…In previous studies, the incidence of candidemia in severe COVID-19 patients varies between 0.8 and 14% [ 1 , 2 ]. In comparison with non-COVID-19 patients, a two- to ten-fold increase in candidemia has been reported in patients with severe COVID-19 [ 3 , 4 , 5 ].…”

Increased incidence of candidemia in critically ill patients during the Coronavirus Disease 2019 (COVID-19) pandemic

“…Such an increase in incidence of candidemia among critically ill COVID-19 patients has been reported from different parts of the world. [ 6 , 7 , 8 , 10 , 11 ]…”

COVID-19-Associated Fungal Infections: An Urgent Need for Alternative Therapeutic Approach?

“…Interestingly, the higher incidence was not driven by patient-to-patient Candida spp. transmission suggesting that individual risk factors might also contribute to the rising number of Candida infections ( Machado et al, 2022 ).…”