The Landscape of Candidemia During the Coronavirus Disease 2019 (COVID-19) Pandemic

Abstract

Background The COVID-19 pandemic has resulted in unprecedented healthcare challenges, and COVID-19 has been linked to secondary infections. Candidemia, a fungal healthcare-associated infection, has been described in patients hospitalized with severe COVID-19. However, studies of candidemia and COVID-19 co-infection have been limited in sample size and geographic scope. We assessed differences in patients with candidemia with and without a COVID-19 diagnosis. Methods We conducted a case-level analysis using population-based candidemia surveillance data collected through the Centers for Disease Control and Prevention’s Emerging Infections Program during April–August 2020 to compare characteristics of candidemia patients with and without a positive test for COVID-19 in the 30 days before their Candida culture using chi-square or Fisher exact tests. Results Of the 251 candidemia patients included, 64 (25.5%) were positive for SARS-CoV-2. Liver disease, solid organ malignancies, and prior surgeries were each >3 times more common in patients without COVID-19 co-infection, whereas intensive care unit-level care, mechanical ventilation, having a central venous catheter, and receipt of corticosteroids and immunosuppressants were each >1.3 times more common in patients with COVID-19. All cause in-hospital fatality was two times higher among those with COVID-19 (62.5%) than without (32.1%). Conclusions One quarter of candidemia patients had COVID-19. These patients were less likely to have certain underlying conditions and recent surgery commonly associated with candidemia and more likely to have acute risk factors linked to COVID-19 care, including immunosuppressive medications. Given the high mortality, it is important for clinicians to remain vigilant and take proactive measures to prevent candidemia in patients with COVID-19.

Invasive Fungal Infections Complicating COVID-19: A Narrative Review

“…The literature search identified 41 articles reporting cases of yeast fungemia during COVID-19 [2,14,15,21,29,30,36,44,45,51,54,60,; most of them were from Italy (9, 22%), followed by the USA (6, 14.6%) and Brazil (4, 9.8%).…”

“…Twenty-five observational studies reported 360 cases of candidemia, with an average incidence of 3.8% [2,14,15,21,29,30,36,44,45,51,54,60,[124][125][126][127][128][129][130][131][132][133][134][135][136] (Table 5; detailed information about the individual studies is given in Table S5). More than 80% of the patients had classic risk factors (an in-dwelling vascular catheter and broad-spectrum antibiotics), but only 21.4% received total parenteral nutrition.…”

“…Candidemia is a typical secondary infection of critically ill patients that is associated with prolonged mechanical ventilation, total parenteral nutrition, broad spectrum antibiotic treatment, in-dwelling blood catheters, glucocorticoid therapy, and abdominal surgery before ICU admission [12,13]. COVID-19 patients admitted to an ICU generally undergo prolonged mechanical ventilation due to severe acute respiratory distress syndrome (ARDS) and receive antimicrobials, and are therefore at greater risk of developing secondary candidemia, which has been reported in a number of studies of COVID-19 [14,15].…”

Diagnosis of invasive fungal disease in coronavirus disease 2019: approaches and pitfalls

“…CAC has been described globally at varying incidences (<1 to 23.5%), mostly presenting as candidaemia 1–2 weeks post admission, caused primarily by Candida albicans and Candida glabrata , although outbreaks caused by multidrug-resistant C. auris continue to be reported [ 3 , 10 , 18 ▪ , 40 – 42 ]. Diagnosis is primarily through the recovery of Candida spp.…”

“…Although Candida risk/colonization scores have shown potential for identifying patients at increased risk of IC, the significant number of clinical interventions and the necessary duration of admission in the ICU mean that critical-care COVID-19 patients are likely exposed to prolonged risk of invasive candidosis [ 18 ▪ , 40 , 49 , 50 ]. It remains unclear what combination of tests will prove optimal for the diagnosis of invasive candidosis in either the COVID-19 or non-COVID-19 population, but a likely combination of molecular, serological and conventional testing will cover the range of targets potentially available in cases of invasive candidosis and when all tests are negative invasive candidosis will be unlikely [ 51 ].…”