Risk factors and lethality associated with Candidemia in severe COVID-19 patients

• Published in: Journal of critical care Vol. 81; p. 154718
• Main Authors: Dursun, Zehra Bestepe, Sipahioğlu, Hilal, Yüksel, Recep Civan, Sav, Hafize, Çelik, Ilhami
• Format: Journal Article
• Language: English
• Published: Philadelphia Elsevier Inc 01-06-2024; Elsevier Limited
• Subjects: Antibiotics; Candidemia; COVID-19; Critical care; Diabetes; Hemoglobin; Intensive care unit; Kidney diseases; Neutrophils; Ventilation; Ventilators; COVID-19; Intensive care unit; Candidemia
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2024.154718

Candidemia remained important in the intensive care units (ICU) during the COVID-19 pandemic. This study aimed at the clinical, and laboratory data on candidemia in COVID-19 patients.
Candidemia and non-candidemia patients were compared baseline characteristics, laboratory and clinical findings. Candidemia was defined as the isolation of Candida spp. from blood cultures. The isolates were identified by VITEK® 2 (bioMérieux, France) commercial method. Antifungal susceptibility was assessed using the E-test method. Univariate and multiple binary logistic regression analyses were performed to compare the variables.
A total of 126 patients with the COVID-19 disease were included. Candidemia was diagnosed in 44 (35%) of the patients. The patients with Diabetes mellitus and chronic renal failure were higher in the candidemia group. In the candidemia group, the duration of ICU stay of patients, the 30-day mortality rate, mechanical ventilation therapy, systemic corticosteroids (Prednisone) usage was significantly higher in candidemia patients. Also, the median white blood cell (WBC), neutrophils (NE), and lactate dehydrogenase (LDH) were higher in the candidemia group. Univariate and multiple binary logistic regression analyses were performed to compare the variables. Isolated species were identified as, 12(41%) C. albicans,7(24%) C. parapsilosis, 6(21%) C. glabrata, and 3(10%) C. tropicalis,1(3%) C.dublinensis Three isolates of six C. glabrata species isolated had dose-dependent sensitivity to FLC, and one C. parapsilosis was determined to be resistant.
COVID -19 patients who are admitted to ICU have many of the risk factors associated with candidemia. The most common risk factors for developing candidemia were mechanical ventilation, diabetes mellitus, neutrophilia, and low hemoglobin. The most frequently isolated species had been C. albicans. CAS was found to be the most effective drug in vitro. No significant resistance pattern was detected against the isolated species. Risk-stratified antifungal prophylaxis in the ICU is possible.