Fungal colonization and infections in patients with COVID-19 in intensive care units: A real-life experience at a tertiary-care hospital

• Published in: Respiratory medicine and research Vol. 82; p. 100937
• Main Authors: Avkan-Oğuz, Vildan, Çelİk, Muammer, Eren-Kutsoylu, Oya Özlem, Nazli, Arzu, Uğur, Yasin Levent, Taylan, Abdullah, Ergan, Begüm, Irmak, Çağlar, Duğral, Esra, Özkütük, A. Aydan
• Format: Journal Article
• Language: English
• Published: Elsevier Masson SAS 01-11-2022; SPLF and Elsevier Masson SAS
• Subjects: Candida albicans; COVID-19; COVID-19-associated pulmonary aspergillosis; Fungal colonization; Fungal infection; Intensive care unit; Original; COVID-19; Candida albicans; COVID-19-associated pulmonary aspergillosis; Fungal colonization; Fungal infection; Intensive care unit
• ISSN: 2590-0412; 2590-0412
• DOI: 10.1016/j.resmer.2022.100937

To evaluate the management of patients with COVID-19 in the intensive care units (ICUs) with fungal infection/colonization and to highlight diagnostic problems in these patients.
We included all patients with a COVID-19 diagnosis who were aged ≥18 years and followed in the ICU for the first 8 months. Patient data were obtained from medical records. We compared the risk factors, laboratory data, and outcomes of patients with fungal infection/colonization.
A total of 118 patients (81 men and 37 women) were included. The mean age was 70.3 ± 14.8 (35–94) years. Of the patients, 79 (66.9%) patients were ≥65 years old. Fungal infection/colonization was detected in 39 (33.1%) patients. Fungi were isolated from 34 (28.8%) patients. Ten fungal species were isolated from 51 samples (the most common being Candida albicans). Three patients (2.5%) had proven candidemia. We observed two (1.7%) possible cases of COVID-19-associated pulmonary aspergillosis (CAPA). Eighteen patients (15.3%) underwent antifungal therapy. The risk of fungal infection/colonization increased as the duration of invasive mechanical ventilation increased. The fatality rate was 61.9% and increased with age and the use of mechanical ventilation. The fatality rate was 4.2-times-higher and the use of mechanical ventilation was 35.9-times-higher in the patients aged ≥65 years than in the patients aged <65 years. No relationship was found between fungal colonization/infection, antifungal treatment, and the fatality rate.
During the pandemic, approximately one-third of the patients in ICUs exhibited fungal infection/colonization. Candida albicans was the most common species of fungal infection as in the pre-pandemic area. Because of the cross-contamination risk, we did not performed diagnostic bronchoscopy and control thorax computed tomography during the ICU stay, and our patients mainly received empirical antifungal therapy.