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

ABSTRACT

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.