ABSTRACT
287 IDWeek 2021). We reinstated mitigation strategies including staff education, line insertion check list and antimicrobial stewardship. 1041 patients with acute COVID-19 were admitted to our hospital in 2021 (January to December) and 6 out 12 cases (50%) of Nosocomial Candidemia were seen in patients with acute COVID-19 infection. We re-evaluated the risk factors and mortality of hospitalized COVID-19 patients with Candidemia. Methods. We performed a retrospective chart review of the 6 patients with Candidemia and confirmed COVID-19 infection at our 292-bed community teaching hospital in Chicago, Illinois from January through December 2021. We report a descriptive analysis of the demographic characteristics, comorbidities, complications, and outcomes of these patients comparing both years. Results. The average age of our study population was 71 years (older);67% were male. The average hospital length of stay (LOS) was shorter 28 days. The mean time from admission to the development of Candidemia was slightly longer 18 days. Associated co-morbidities included cardiovascular diseases (CVD) in 83%, diabetes mellitus (DM), in 50%, and obesity in 50%. Treatments for COVID-19 included Steroids (100%), Remdesivir (50%) and Baricitinib (33%). All patients were managed in the intensive care unit (ICU) and 67% had a central in place at the time of Candidemia. Half of the patients (50%) required hemodialysis (HD);all patients were treated with multiple antibiotics. The average LOS in the ICU was 18 days (shorter). Despite antifungal treatment, 80% expired. Conclusion. Incidence of Candidemia in acute COVID-19 infections decreased by 56% in one year after reinstating mitigation strategies in our hospital. However, Candidemia remains a menace in hospitalized patients with acute COVID-19 infection. Associated risk factors remain history of CVD, DM, obesity, prolonged hospital LOS, requirement for multiple CL, HD, treatment with multiple antibiotics, treatment with steroids (100%) and a long stay in the ICU. The mortality of COVID-19 patients with Candidemia remains very high.
ABSTRACT
Background. 1,416 patients with acute COVID-19 infection were admitted to our hospital in 2020. During that year we noticed an alarming increase in cases of nosocomial Candidemia: 26 versus an average of 2.8 cases per year over the previous 5 years. 19 of the 26 episodes (73%) of Candidemia occurred in patients who were admitted with acute COVID-19 infection. Recent reports suggest that hospitalized patients with COVID-19 are at increased risk for developing Candidemia, however their clinical characteristics, risk factors and outcomes have not been well described. We evaluated the risk factors and mortality of hospitalized COVID-19 patients with Candidemia. Methods. We performed a retrospective chart review of 19 patients with Candidemia and confirmed COVID-19 infection at a 292-bed community teaching hospital in Chicago, Illinois from January through December 2020. We report a descriptive analysis of the demographic characteristics, comorbidities, complications, and outcomes of these patients. Results. The average age of our study population was 65 years;68% were male. The average hospital length of stay (LOS) was 34 days. The mean time from admission to the development of Candidemia was 16 days. Associated co-morbidities included cardiovascular diseases (CVD) in 79%, diabetes mellitus (DM), in 68%, and obesity in 50%. Underlying kidney disease was present in 10%. Treatments for COVID-19 included convalescent plasma (53%), remdesivir (53%), steroids (52%) and tocilizumab (19%). All patients were managed in the intensive care unit (ICU) and 95% required multiple central line (CL) placements. Most of the patients (58%) required hemodialysis (HD);all patients were treated with multiple antibiotics. The average LOS in the ICU was 25 days. Despite anti-fungal treatment, 68% expired. The 28-day mortality was 50%. Conclusion. The occurrence of Candidemia in our hospitalized patients with acute COVID-19 infection was associated with a history of CVD, DM, obesity, prolonged hospital LOS, requirement for multiple CL, HD, treatment with multiple antibiotics and a long stay in the ICU. The mortality of COVID-19 patients with Candidemia is high. The development of strategies to mitigate the occurrence of nosocomial Candidemia in this population of patients is urgently needed.