Multicentre Surveillance of Candida Species from Blood Cultures during the SARS-CoV-2 Pandemic in Southern Europe (CANCoVEU Project)

Abstract

Introduction: Surveillance of Candida species isolates from blood cultures (BCs) in Europe is considered fragmented, unable to allow the definition of targets of antifungal stewardship recommendations especially during the SARS-CoV-2 pandemic. Methods: We performed a multicentric retrospective study including all consecutive BC Candida isolates from six Southern European tertiary hospitals (1st January 2020 to 31st December 2021). Etiology, antifungal susceptibility patterns, and clinical setting were analyzed and compared. Results: C. albicans was the dominant species (45.1%), while C. auris was undetected. Candida species positive BC events increased significantly in COVID-19 ICUs in 2021 but decreased in other ICUs. Resistance to azole increased significantly and remained very high in C. albicans (fluconazole from 0.7% to 4.5%, p = 0.03) and C. parapsilosis complex (fluconazole up to 24.5% and voriconazole up to 8.9%), respectively. Resistance to caspofungin was remarkable in C. tropicalis (10%) and C. krusei (20%), while resistance to at least one echinocandin increased in 2021, especially in C. parapsilosis complex (from 0.8% to 5.1%, p = 0.05). Although no significant differences were observed over the study period, fluconazole and echinocandin resistance increased in COVID-19 ICUs by up to 14% and 5.8%, respectively, but remained undetected in non-intensive COVID-19 wards. Conclusions: Antifungal stewardship activities aimed at monitoring resistance to echinocandin in C. tropicalis and C. krusei, and against the spread of fluconazole resistant C. parapsilosis complex isolates are highly desirable. In COVID-19 patients, antifungal resistance was mostly present when the illness had a critical course.

Insights into Candida Colonization in Intensive Care Unit Patients: A Prospective Multicenter Study

“…To the authors’ knowledge, this is the first Portuguese multicenter observational and descriptive study that provides insights into Candida colonization and predictive risk factors in an ICU setting. Previous studies conducted in Portugal have predominantly focused on cases of candidemia, often being retrospective in nature [ 25 , 26 , 27 ]. Nevertheless, comparing the overall distribution of Candida species with previous Portuguese candidemia studies, a steady pattern of Candida species ranks yielded by Portuguese ICU patients was observed [ 28 ].…”

“…Nevertheless, comparing the overall distribution of Candida species with previous Portuguese candidemia studies, a steady pattern of Candida species ranks yielded by Portuguese ICU patients was observed [ 28 ]. Namely, a prevalence of C. albicans alongside the occurrence of cryptic species only from the C. parapsilosis complex [ 26 , 28 , 29 ].…”

Risk factors for healthcare-associated candidemia in adults hospitalized with SARS-CoV-2 infection

“…Patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, the virus that causes COVID-19, are at increased risk for secondary infections with Candida spp., which can be severe and life-threatening. [1][2][3][4] Prior studies identified risk factors for healthcare-associated candidiasis in patients hospitalized with COVID-19, including age, length of intensive care unit (ICU) stay, comorbidities, central venous catheters, mechanical ventilation, extracorporeal membrane oxygenation (ECMO), antibiotic exposure, and Candida colonization. [5][6][7] It remains unclear if there are any risk factors for candidiasis that are unique to patients with COVID-19, including use of immunosuppressive medications such as corticosteroids and interleukin-6 (IL-6) inhibitors.…”