The Impact of COVID-19 on the Epidemiology and Outcomes of Candidemia: A Retrospective Study from a Tertiary Care Center in Lebanon

The impact of the COVID-19 on the antifungal consumption and antifungal resistance in Candida species isolated from the blood cultures of critically ill patients in intensive care units

Incidence of Candida species increased in critically ill COVID-19 patients in intensive care units. This study aimed to investigate the impact of the COVID-19 pandemic on antifungal consumption and Candida species distribution in bloodstream infections. We observed that a significant increase in non-albicansCandida species cases (P = .005) in 2021 coincided with higher rates of fluconazole resistance (P = .002) and increased minimum inhibitory concentrations for echinocandins (P = .012). Notably, voriconazole consumption and increased MIC levels positively correlated with both Candida albicans and non-albicansCandida species. This study underscores the importance of judicious antifungal use during the COVID-19 pandemic.

Invasive candidiasis

Invasive candidiasis is an important fungal disease caused by Candida albicans and, increasingly, non-albicans Candida pathogens. Invasive Candida infections originate most frequently from endogenous human reservoirs and are triggered by impaired host defences. Signs and symptoms of invasive candidiasis are non-specific; candidaemia is the most diagnosed manifestation, with disseminated candidiasis affecting single or multiple organs. Diagnosis poses many challenges, and conventional culture techniques are frequently supplemented by non-culture-based assays. The attributable mortality from candidaemia and disseminated infections is ~30%. Fluconazole resistance is a concern for Nakaseomyces glabratus, Candida parapsilosis, and Candida auris and less so in Candida tropicalis infection; acquired echinocandin resistance remains uncommon. The epidemiology of invasive candidiasis varies in different geographical areas and within various patient populations. Risk factors include intensive care unit stay, central venous catheter use, broad-spectrum antibiotics use, abdominal surgery and immune suppression. Early antifungal treatment and central venous catheter removal form the cornerstones to decrease mortality. The landscape of novel therapeutics is growing; however, the application of new drugs requires careful selection of eligible patients as the spectrum of activity is limited to a few fungal species. Unanswered questions and knowledge gaps define future research priorities and a personalized approach to diagnosis and treatment of invasive candidiasis is of paramount importance.