Original Article

Risk analysis of candidemia and its effect on mortality in COVID 19 and non COVID 19 patients

Abstract

Background and Objectives: Candidemia is the most common serious fungal infection in critically ill patients in intensive care units (ICU). It series fourth among bloodstream infectious agents. In this study, candidemia risk analysis was examined in COVID 19 and non-COVID 19 patients during the pandemic period.
Materials and Methods: COVID 19 and non-COVID 19 cases who were followed up with candidemia in the ICU of our hospital were retrospectively screened. Demographic data, intubation, central venous catheter (CVC), medications, and total parenteral nutrition (TPN) status were evaluated in terms of risk between the two groups. Isolated Candida species and susceptibilty were evaluated.
Results: When age, gender, medication, intubation, TPN and CVC were evaluated, no difference was seen in terms of risk. Differences were detected in terms of comorbidities. While the most frequently identified Candida species was C. albicans, the most frequently detected species in the COVID19 patient group was C. parapsilosis.
Conclusion: There was no difference in candidemia incidence and risk factors between the two groups. Since candidemias were evaluated in terms of comorbidities, it was determined that Diabetes Mellitus (DM) and chronic obstructive pulmoner disease (COPD) were more common in patients with COVID 19 and less common in coronary artery disease (CAD) and malignancy.

1. McCarty TP, White CM, Pappas PG. Candidemia and invasive Candidiasis. Infect Dis Clin North Am 2021; 35: 389-413.
2. Kim EJ, Lee E, Kwak YG, Yoo HM, Choi JY, Kim SR, et al. Trends in the Epidemiology of Candidemia in intensive care units from 2006 to 2017: results from the Korean national healthcare-associated infections surveillance system. Front Med (Lausanne) 2020; 7: 606976.
3. Dixit D, Jen P, Maxwell TD, Smoke ST, McCracken JA, Cardinale-King M, et al. Risk factors and clinical outcomes of Candidemia associated with severe COVID-19. Crit Care Explor 2022; 4(9): e0762.
4. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72314 cases from the Chinese center for disease control and prevention. JAMA 2020; 323: 1239-1242.
5. Wunsch H. Mechanical ventilation in COVID-19: interpreting the current epidemiology. Am J Respir Crit Care Med 2020; 202: 1-4.
6. Zia M, Goli M. Predisposing factors of important invasive fungal coinfections in COVID-19 patients: a review article. J Int Med Res 2021; 49: 3000605211043413.
7. Macauley P, Epelbaum O. Epidemiology and Mycology of Candidaemia in non-oncological medical intensive care unit patients in a tertiary center in the United States: overall analysis and comparison between non-COVID-19 and COVID-19 cases. Mycoses 2021; 64: 634-640.8. Nucci M, Barreiros G, Guimarães LF, Deriquehem VAS, Castiñeiras AC,
Nouér SA. Increased incidence of candidemia in a tertiary care hospital with the COVID-19 pandemic. Mycoses 2021; 64: 152-156.
9. Kayaaslan B, Eser F, Kalem AK, Bilgic Z, Asilturk D, Hasanoglu I, et al. Characteristics of candidemia in COVID-19 patients; increased incidence, earlier occurrence and higher mortality rates compared to non-COVID-19 patients. Mycoses 2021; 64: 1083-1091.
10. Baddley JW, Thompson GR 3rd, Chen SC, White PL, Johnson MD, Nguyen MH, et al. Coronavirus disease 2019-associated invasive fungal infection. Open Forum Infect Dis 2021; 8: ofab510.
11. Machado M, Estévez A, Sánchez-Carrillo C, Guinea J, Escribano P, Alonso R, et al. Incidence of Candidemia is higher in COVID-19 versus non-COVID-19 patients, but not driven by intrahospital transmission. J Fungi (Basel) 2022; 8: 305.
12. Riche CVW, Cassol R, Pasqualotto AC. Is the frequency of Candidemia increasing in COVID-19 patients receiving Corticosteroids? J Fungi (Basel) 2020; 6: 286.
13. Antinori S, Bonazzetti C, Gubertini G, Capetti A, Pagani C, Morena V, et al. Tocilizumab for cytokine storm syndrome in COVID-19 pneumonia: An increased risk for Candidemia? Autoimmun Rev 2020; 19: 102564.
14. Buil JB, Schouten JA, Wauters J, van de Hoeven H, Verweij PE, CAC-SDD study group. Absence of Candidemia in critically ill patients with COVID-19 receiving selective digestive decontamination. Intensive Care Med 2022; 48: 611-612.
15. Seagle EM, Jackson BR, Lockhart SR, Georgacopoulos O, Nunnally NS, Roland J, et al. The landscape of Candidemia during the Coronavirus disease 2019 (COVID-19) pandemic. Clin Infect Dis 2022; 74: 802-811.
16. Arastehfar A, Carvalho A, Nguyen MH, Hedayati MT, Netea MG, Perlin DS, et al. COVID-19-associated Candidiasis (CAC): an underestimated complication in the absence of immunological predispositions? J Fungi (Basel) 2020; 6: 211.
17. Toht R, Nosek J, MoraMontes HM, Gabaldon T, Bliss JM, Nosanchuk JD, et al. Candida parapsilosis: from genes to the bedside. Clin Microbiol Rev 2019; 32(2): e00111-18.
18. Sui J, Noubouossie DF, Gandotra S, Cao L. Elevated plasma Fibrinogen is associated with excessive inflammation and disease severity in COVID-19 patients. Front Cell Infect Microbiol 2021; 11: 734005.
19. Ali N. Elevated level of C-reactive protein may be an early marker to predict risk for severity of COVID-19. J Med Virol 2020; 92: 2409-2411.
20. Rocco TR, Reinsert SE, Simms HH. Effects of fluconazole administration in critically ill patients: analysis of bacterial and fungal resistance. Arch Surg 2000; 135: 160-165.
21. Luzzati R, Amalfitano G, Lazzarini L, Soldani F, Bellino S, Solbiati M, et al. Nosocomial candidemia in non-neutropenic patients at an Italian tertiary care hospital. Eur J Clin Microbiol Infect Dis 2000; 19: 602-607.
22. Safdar A, Perlin DS, Armstrong D. Hematogenous infections due to Candida parapsilosis: changing trends in fungemic patients at a comprehensive cancer center during the last four decades. Diagn Microbiol Infect Dis 2002; 44: 11-16.
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IssueVol 16 No 2 (2024) QRcode
SectionOriginal Article(s)
DOI https://doi.org/10.18502/ijm.v16i2.15357
Keywords
Bloodstream infections; Candidemia; COVID 19
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Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Özmerdiven G, İrvem A, Şahin A. Risk analysis of candidemia and its effect on mortality in COVID 19 and non COVID 19 patients. Iran J Microbiol. 2024;16(2):236-242.