Epidemiology of Candidemia and Fluconazole Resistance in an ICU before and during the COVID-19 Pandemic Era

Abstract

The objectives of this study were to investigate the incidence of candidemia, as well as the factors associated with Candida species distribution and fluconazole resistance, among patients admitted to the intensive care unit (ICU) during the COVID-19 pandemic, as compared to two pre-pandemic periods. All patients admitted to the ICU due to COVID-19 from March 2020 to October 2021, as well as during two pre-pandemic periods (2005–2008 and 2012–2015), who developed candidemia, were included. During the COVID-19 study period, the incidence of candidemia was 10.2%, significantly higher compared with 3.2% and 4.2% in the two pre-pandemic periods, respectively. The proportion of non-albicans Candida species increased (from 60.6% to 62.3% and 75.8%, respectively), with a predominance of C. parapsilosis. A marked increase in fluconazole resistance (from 31% to 37.7% and 48.4%, respectively) was also observed. Regarding the total patient population with candidemia (n = 205), fluconazole resistance was independently associated with ICU length of stay (LOS) before candidemia (OR 1.03; CI: 1.01–1.06, p = 0.003), whereas the presence of shock at candidemia onset was associated with C. albicans (OR 6.89; CI: 2.2–25, p = 0.001), and with fluconazole-susceptible species (OR 0.23; CI: 0.07–0.64, p = 0.006). In conclusion, substantial increases in the incidence of candidemia, in non-albicansCandida species, and in fluconazole resistance were found in patients admitted to the ICU due to COVID-19, compared to pre-pandemic periods. At candidemia onset, prolonged ICU LOS was associated with fluconazole-resistant and the presence of shock with fluconazole-susceptible species.

Risk Factors for Candidemia in Intensive Care Unit: A Matched Case Control Study from North-Western India

“…This variation may be due to the timing of our observation which is done during pandemic era while the previous mentioned Indian data is from pre-pandemic period. Routsi et al, and several other researchers have observed that the incidence of candidemia increased significantly during the COVID-19 pandemic in comparison to pre-COVID era (11). More than threefourth of the patients (83%) with candidemia were more than 60 years of age similar to most other studies (5,12).…”

Fluconazole-resistant Candida parapsilosis: A new emerging threat in the fungi arena

“…Conversely, a study conducted in another Madrid hospital showed that C. parapsilosis candidaemia episodes increased significantly during the pandemic period, including the number of cases caused by a fluconazoleresistant C. parapsilosis genotype harbouring the Y132F ERG11p substitution and spreading at that time (Ramos-Martinez et al, 2022). In line with these observations, another study conducted in Greece showed that both the incidence of candidaemia and fluconazole resistance in C. parapsilosis increased during the pandemic; unfortunately, the isolates were not molecular characterized (Routsi et al, 2022). In the Madrid study, many resistant isolates showed up before the COVID-19 pandemic; however, their spread become more evident during the pandemic, suggesting that all triggers increasing the number of candidaemia cases may have been effective in terms of promoting the clonal spread of resistant isolates (Ramos-Martinez et al, 2022).…”

The impact of COVID-19 on multidrug-resistant organisms causing healthcare-associated infections: a narrative review

“…A rise in the rate of fluconazole-resistant Candida parapsilosis was noted in Europe. 22 , 57 Outbreaks of this organism were also described in two connected hospitals in Brazil, 58 likely resulting from a shared, contaminated CT scanner. Outbreaks were reported in Spain, 59 and in Turkey, where the acceleration of an on-going resistant C. parapsilosis outbreak, present since 2015, was confirmed using WGS.…”