COVID-19 and C. auris: A Case-Control Study from a Tertiary Care Center in Lebanon

Abstract

Many healthcare centers around the world have reported the surge of Candida auris (C. auris) outbreaks during the COVID-19 pandemic, especially among intensive care unit (ICU) patients. This is a retrospective study conducted at the American University of Beirut Medical Center (AUBMC) between 1 October 2020 and 15 June 2021, to identify risk factors for acquiring C. auris in patients with severe COVID-19 infection and to evaluate the impact of C. auris on mortality in patients admitted to the ICU during that period. Twenty-four non-COVID-19 (COV−) patients were admitted to ICUs at AUBMC during that period and acquired C. auris (C. auris+/COV−). Thirty-two patients admitted with severe COVID-19 (COV+) acquired C. auris (C. auris+/COV+), and 130 patients had severe COVID-19 without C. auris (C. auris−/COV+). Bivariable analysis between the groups of (C. auris+/COV+) and (C. auris−/COV+) showed that higher quick sequential organ failure assessment (qSOFA) score (p < 0.001), prolonged length of stay (LOS) (p = 0.02), and the presence of a urinary catheter (p = 0.015) or of a central venous catheter (CVC) (p = 0.01) were associated with positive culture for C. auris in patients with severe COVID-19. The multivariable analysis showed that prolonged LOS (p = 0.008) and a high qSOFA score (p < 0.001) were the only risk factors independently associated with positive culture for C. auris. Increased LOS (p = 0.02), high “Candida score” (p = 0.01), and septic shock (p < 0.001) were associated with increased mortality within 30 days of positive culture for C. auris. Antifungal therapy for at least 7 days (p = 0.03) appeared to decrease mortality within 30 days of positive culture for C. auris. Only septic shock was associated with increased mortality in patients with C. auris (p = 0.006) in the multivariable analysis. C. auris is an emerging pathogen that constitutes a threat to the healthcare sector.

A Candida auris –specific adhesin, Scf1 , governs surface association, colonization, and virulence

“…C. auris outbreaks are characterized by persistent colonization of patient skin and abiotic surfaces, which can remain positive for extensive periods and serve as a source of contaminative transmission (8)(9)(10)(11)(12)(13)(14). C. auris also colonizes indwelling medical devices, which act as a risk factor for the development of invasive disease (15)(16)(17)(18)(19)(20)(21). Lapses in diagnostic screening and infection prevention measures are thought to contribute to the increasing rate of C. auris outbreaks (20).…”

The battle against fungi: lessons in antifungal stewardship from COVID 19 times

“…Most patients with severe COVID-19 require ICU admission and immunosuppressive therapy, central venous catheter, parenteral nutrition, and mechanical ventilation. These factors, along with advanced age and high Sequential Organ Failure Assessment score, have been linked to a higher risk of candidemia [77] , [78] , [79] , [80] , which is challenging for the management of these patients, particularly in the setting of a pandemic [81] . Nevertheless, adherence to evidence-based central line-associated BSI prevention bundles can reduce candidemia, alongside the early removal of the catheter, whenever possible [82 , 83] .…”

Candida Species Isolation from Hospitalized Patients with COVID-19—A Retrospective Study

“…In the present study, C. auris was identified in only one culture. It is possible that the infection control measures that apply in the era of the COVID-19 pandemic could have altered the spread of this emerging fungus [ 30 , 31 ].…”