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

Abstract

Whether severe COVID-19 is by itself a significant risk factor for the development of candidemia currently remains an open question as conflicting results have been published. We aim to assess the occurrence of candidemia in patients with severe COVID-19 admitted to the intensive care unit (ICU). We conducted a retrospective study on patients with severe SARS-CoV-2-related pneumonia admitted to 5 ICUs in France who were specifically screened for fungal complications between March 2020 and January 2021. The study population included a total of 264 patients; the median age was 56 years old and most of them were male (n = 186; 70.5%) and immunocompetent (n = 225; 87.5%), and 62.7% (n = 153/244) were on extracorporeal membrane oxygenation support. Microbiological analysis included 4864 blood culture samples and beta-glucan test performed on 975 sera. Candidemia was diagnosed in 13 (4.9%) patients. The species involved were mainly C. albicans (n = 6) and C. parapsilosis (n = 5). Almost all patients (12/13; 92.3%) had a colonization by yeasts. ICU mortality was not significantly impacted by the occurrence of candidemia. Unrelated positive beta-glucan tests were observed in 49 patients (23.4%), including 6 with mold infections and 43 with false positive results. In our series, patients with severe SARS-CoV-2-related pneumonia seemed at low risk of developing invasive candidiasis.

Fungal Infections in the ICU during the COVID-19 Era: Descriptive and Comparative Analysis of 178 Patients

“…In the present study, the total incidence of fungal infections (10.7%), CAPA (7.86%), and CAC (3.37%) were similar to those already described in the literature [ 1 , 10 , 12 , 13 , 14 ]. It is also noteworthy that in the subgroup of ECMO patients, fungal infections were far more common (6/11, 54.5%).…”

“…Thus, it remains fairly unclear whether the excess mortality observed in patients diagnosed with CAPA should be attributed to CAPA per se or to the co-existence of other risk factors potentially driving both vulnerability to CAPA and a high all-cause ICU mortality rate [ 18 ]. Recent data on CAC show that patients with CAC might not have differences in mortality [ 10 ].…”

“…The exact impact of fungal infections on critical COVID-19 remains incompletely understood. Estimations of CAPA prevalence reported to date are highly variable, ranging from 0–33% in COVID-19 ICU patients across the world [ 16 ], and estimations of CAC prevalence for intubated patients are around 5% [ 10 ]. Most of these data originated from small studies in the first wave of the pandemic, during which awareness on fungal infections (especially CAPA) was not yet raised, diagnostic bronchoscopy use was rather limited due to concerns over viral transmission to health-care workers through aerosol exposure, and specific diagnostic criteria for CAPA were still lacking.…”

“…An increased incidence of secondary bacterial and fungal infections has been reported in critically ill patients with COVID-19-associated ARDS [ 2 ] and may contribute significantly to adverse outcomes [ 3 ]. Among fungal infections, invasive pulmonary mycosis caused by Aspergillus species and candidemia, for which the terms COVID-19-associated pulmonary aspergillosis (CAPA) and COVID-19 associated candidemia (CAC) have been coined, respectively, have attracted much attention as emerging clinical entities complicating critical COVID-19 [ 4 , 5 , 6 , 7 , 8 , 9 , 10 ].…”

COVID-19 and Fungal infections: a double debacle

“…Otherwise, these techniques pose a significant challenge due to some limitations. A French retrospective study reported that BDG testing lacked sufficient sensitivity and specificity when performed on sera collected from patients with severe COVID-19 admitted to the ICU ( 102 ). Serum BDG testing has been broadly used in COVID-19 patients for the detection of CAPA in developed countries, in contrast to not being available in developing countries ( 103 ).…”