Candidemia Among Coronavirus Disease 2019 Patients in Turkey Admitted to Intensive Care Units: A Retrospective Multicenter Study.

Background: We evaluated the epidemiology of candidemia among coronavirus disease 2019 (COVID-19) patients admitted to intensive care units (ICUs). Methods: We conducted a retrospective multicenter study in Turkey between April and December 2020. Results: Twenty-eight of 148 enrolled patients developed candidemia, yielding an incidence of 19% and incidence rate of 14/1000 patient-days. The probability of acquiring candidemia at 10, 20, and 30 days of ICU admission was 6%, 26%, and 50%, respectively. More than 80% of patients received antibiotics, corticosteroid, and mechanical ventilation. Receipt of a carbapenem (odds ratio [OR] = 6.0, 95% confidence interval [CI] = 1.6-22.3, P = .008), central venous catheter (OR = 4.3, 95% CI = 1.3-14.2, P = .02), and bacteremia preceding candidemia (OR = 6.6, 95% CI = 2.1-20.1, P = .001) were independent risk factors for candidemia. The mortality rate did not differ between patients with and without candidemia. Age (OR = 1.05, 95% CI = 1.01-1.09, P = .02) and mechanical ventilation (OR = 61, 95% CI = 15.8-234.9, P < .0001) were independent risk factors for death. Candida albicans was the most prevalent species overall. In Izmir, Candida parapsilosis accounted for 50% (2 of 4) of candidemia. Both C parapsilosis isolates were fluconazole nonsusceptible, harbored Erg11-Y132F mutation, and were clonal based on whole-genome sequencing. The 2 infected patients resided in ICUs with ongoing outbreaks due to fluconazole-resistant C parapsilosis. Conclusions: Physicians should be aware of the elevated risk for candidemia among patients with COVID-19 who require ICU care. Prolonged ICU exposure and ICU practices rendered to COVID-19 patients are important contributing factors to candidemia. Emphasis should be placed on (1) heightened infection control in the ICU and (2) developing antibiotic stewardship strategies to reduce irrational antimicrobial therapy.

Candidemia among COVID-19 patients in Turkey admitted to ICUs: A retrospective multicenter study

Objectives We evaluated the epidemiology of candidemia among COVID-19 patients admitted to intensive care units (ICUs). Methods We conducted a retrospective multicenter study in Turkey between April- December 2020. Results Twenty-eight of 148 enrolled patients developed candidemia, yielding an incidence of 19% and incidence rate of 14/1,000 patient-days. The probability of acquiring candidemia at 10, 20 and 30 days of ICU admission was 6%, 26% and 50%, respectively. Over 80% of patients received antibiotics, corticosteroid and mechanical ventilation. Receipt of a carbapenem (odds ratio and 95% confidence interval (OR, 95% CI) of 6.0 (1.6–22.3), P=0.008), central venous catheter (4.3 (1.3–14.2), P=0.02) and bacteremia preceding candidemia (6.6 (2.1–20.1), P=0.001) were independent risk factors for candidemia. Mortality rate did not differ between patients with and without candidemia. Age (1.05 (1.01–1.09), P=0.02) and mechanical ventilation (61 (15.8–234.9), P<0.0001) were independent risk factors for death. Candida albicans was the most prevalent species overall. In Izmir, C. parapsilosis accounted for 50% (2/4) of candidemia. Both C. parapsilosis isolates were fluconazole non-susceptible, harbored Erg11-Y132F mutation, and were clonal based on whole-genome sequencing. The two infected patients resided in ICUs with ongoing outbreaks due to fluconazole-resistant C. parapsilosis. Conclusions Physicians should be aware of the elevated risk for candidemia among COVID-19 patients requiring ICU care. Prolonged ICU exposure and ICU practices rendered to COVID-19 patients are important contributing factors to candidemia. Emphasis should be placed on heightened infection control in the ICU, and developing antibiotic stewardship strategies to reduce irrational antimicrobial therapy.