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Kozlova O, Burygina E, Khostelidi S, Shadrivova O, Saturnov A, Gusev D, Rysev A, Zavrazhnov A, Vashukova M, Pichugina G, Mitichkin M, Kovyrshin S, Bogomolova T, Borzova Y, Oganesyan E, Vasilyeva N, Klimko N. Invasive Candidiasis in Adult Patients with COVID-19: Results of a Multicenter Study in St. Petersburg, Russia. J Fungi (Basel) 2023; 9:927. [PMID: 37755035 PMCID: PMC10532874 DOI: 10.3390/jof9090927] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/10/2023] [Accepted: 09/12/2023] [Indexed: 09/28/2023] Open
Abstract
We studied the risk factors, etiology, clinical manifestations, and treatment outcomes of COVID-19-associated invasive candidiasis (COVID-IC) in adult patients admitted to six medical facilities in St. Petersburg. (November 2020-December 2022). In this retrospective study, we included 72 patients with COVID-IC with a median age of 61 years (range 29-96), 51% of whom were women. The predisposing factors for COVID-IC were a central venous catheter (CVC) for more than 10 days (the odds ratio (OR) = 70 [15-309]), abdominal surgical treatment performed in the previous 2 weeks (OR = 8.8 [1.9-40.3]), bacteremia (OR = 10.6 [4.8-23.3]), pulmonary ventilation (OR = 12.9 [5.9-28.4]), and hemodialysis (OR = 11.5 [2.5-50.8]). The signs and symptoms of COVID-IC were non-specific: fever (59%), renal failure (33%), liver failure (23%), and cardiovascular failure (10%). Candida albicans (41%) predominated among the pathogens of the candidemia. The multidrug-resistant Candida species C. auris (23%) and C. glabrata (5%) were also identified. Empirical therapy was used in 21% of COVID-IC patients: azole-93%, echinocandin-7%. The majority of COVID-IC patients (79%) received, after laboratory confirmation of the diagnosis of IC, fluconazole (47%), voriconazole (25%), echinocandin (26%), and amphotericin B (2)%. The 30 days overall survival rate was 45%. The prognosis worsened concomitant bacteremia, hemodialysis, and long-term therapy by systemic glucocorticosteroids (SGCs), bronchial colonization with Candida spp. The survival prognosis was improved by the early change/replacement of CVC (within 24 h), the initiation of empirical therapy, and the use of echinocandin. Conclusions: We highlighted the risk factors that predispose COVID-19 patients to candidiasis and worsen the survival prognosis. Their individual effects in patients with COVID-19 must be well understood to prevent the development of opportunistic co-infections that drastically lower chances of survival.
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Affiliation(s)
- Olga Kozlova
- Kashkin Research Institute of Medical Mycology; North-Western State Medical University Named after I.I. Mechnikov, 191015 Saint-Petersburg, Russia; (E.B.); (S.K.); (O.S.); (S.K.); (T.B.); (Y.B.); (E.O.); (N.V.); (N.K.)
| | - Ekaterina Burygina
- Kashkin Research Institute of Medical Mycology; North-Western State Medical University Named after I.I. Mechnikov, 191015 Saint-Petersburg, Russia; (E.B.); (S.K.); (O.S.); (S.K.); (T.B.); (Y.B.); (E.O.); (N.V.); (N.K.)
| | - Sofya Khostelidi
- Kashkin Research Institute of Medical Mycology; North-Western State Medical University Named after I.I. Mechnikov, 191015 Saint-Petersburg, Russia; (E.B.); (S.K.); (O.S.); (S.K.); (T.B.); (Y.B.); (E.O.); (N.V.); (N.K.)
| | - Olga Shadrivova
- Kashkin Research Institute of Medical Mycology; North-Western State Medical University Named after I.I. Mechnikov, 191015 Saint-Petersburg, Russia; (E.B.); (S.K.); (O.S.); (S.K.); (T.B.); (Y.B.); (E.O.); (N.V.); (N.K.)
| | - Andrey Saturnov
- Leningrad Regional Hospital, 194291 Saint-Petersburg, Russia;
| | - Denis Gusev
- Botkin’s Hospital, 195067 Saint-Petersburg, Russia; (D.G.); (M.V.)
| | - Aleksandr Rysev
- Saint Petersburg Research Institute of Emergency Medicine n.a. I.I. Dzhanelidze, 192242 Saint-Petersburg, Russia; (A.R.); (G.P.)
| | | | - Maria Vashukova
- Botkin’s Hospital, 195067 Saint-Petersburg, Russia; (D.G.); (M.V.)
| | - Galina Pichugina
- Saint Petersburg Research Institute of Emergency Medicine n.a. I.I. Dzhanelidze, 192242 Saint-Petersburg, Russia; (A.R.); (G.P.)
| | - Mikhail Mitichkin
- City Mariinskaya Hospital, 191014 Saint-Petersburg, Russia; (A.Z.); (M.M.)
| | - Sergey Kovyrshin
- Kashkin Research Institute of Medical Mycology; North-Western State Medical University Named after I.I. Mechnikov, 191015 Saint-Petersburg, Russia; (E.B.); (S.K.); (O.S.); (S.K.); (T.B.); (Y.B.); (E.O.); (N.V.); (N.K.)
| | - Tatiana Bogomolova
- Kashkin Research Institute of Medical Mycology; North-Western State Medical University Named after I.I. Mechnikov, 191015 Saint-Petersburg, Russia; (E.B.); (S.K.); (O.S.); (S.K.); (T.B.); (Y.B.); (E.O.); (N.V.); (N.K.)
| | - Yulia Borzova
- Kashkin Research Institute of Medical Mycology; North-Western State Medical University Named after I.I. Mechnikov, 191015 Saint-Petersburg, Russia; (E.B.); (S.K.); (O.S.); (S.K.); (T.B.); (Y.B.); (E.O.); (N.V.); (N.K.)
| | - Ellina Oganesyan
- Kashkin Research Institute of Medical Mycology; North-Western State Medical University Named after I.I. Mechnikov, 191015 Saint-Petersburg, Russia; (E.B.); (S.K.); (O.S.); (S.K.); (T.B.); (Y.B.); (E.O.); (N.V.); (N.K.)
| | - Natalya Vasilyeva
- Kashkin Research Institute of Medical Mycology; North-Western State Medical University Named after I.I. Mechnikov, 191015 Saint-Petersburg, Russia; (E.B.); (S.K.); (O.S.); (S.K.); (T.B.); (Y.B.); (E.O.); (N.V.); (N.K.)
| | - Nikolay Klimko
- Kashkin Research Institute of Medical Mycology; North-Western State Medical University Named after I.I. Mechnikov, 191015 Saint-Petersburg, Russia; (E.B.); (S.K.); (O.S.); (S.K.); (T.B.); (Y.B.); (E.O.); (N.V.); (N.K.)
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