Background

As the COVID-19 pandemic unfolded, patients with severe illness faced numerous complications, including invasive fungal infections like candidaemia, which can lead to significant mortality. This retrospective multicentre study aimed to compare the clinical characteristics and outcomes of patients with candidaemia who also had COVID-19 against those without the virus. Understanding this relationship is crucial as it sheds light on the potential risks and prognoses for critically ill patients.

Methods

Conducted across four major tertiary hospitals in South Korea from January 2020 to December 2022, this study involved analyzing the medical records of 355 candidaemia patients aged 18 and older. The COVID-19 group consisted of individuals diagnosed with the virus within 30 days prior to experiencing candidaemia. The research team used rigorous statistical methods to investigate the clinical features and outcomes, with multivariate logistic regression identifying key risk factors for 30-day mortality.

Results

Out of the studied patients, 39 (11.0%) were found to have had a prior COVID-19 diagnosis. Alarmingly, those in the COVID-19 group displayed significantly higher instances of systemic corticosteroid use (20.5% vs. 8.9%), reliance on central venous catheters (74.4% vs. 57.3%), and mechanical ventilation (53.8% vs. 31.6%). The COVID-19 cohort also had a markedly increased rate of septic shock at candidaemia onset (61.5% vs. 32.0%) and a staggering 30-day mortality rate (69.2% vs. 50.9%).

Conclusions

While COVID-19 did not emerge as a direct independent risk factor for death in candidaemia patients, those with prior COVID-19 represented a more critical demographic, often requiring more intensive interventions like mechanical ventilation. This study highlights the pressing need for vigilant monitoring and proactive measures to curb candidaemia occurrences in severely ill COVID-19 patients.

Additional Insights

The findings are underscored by an alarming health landscape during the pandemic, with reports indicating that the incidence of candidaemia increased among COVID-19 patients. Studies reveal that many of these cases are associated with healthcare-related factors, particularly in patients receiving intensive care. Corticosteroid use, a common treatment for severe COVID-19 cases, has been linked to the heightened risk of candidaemia, complicating the management of such patients.

Research indicates that COVID-19 paves the way for healthcare-associated infections, introducing additional layers of difficulty for healthcare providers. According to a meta-analysis, mortality rates for candidaemia patients with concurrent COVID-19 were shockingly high, soaring into the 60-90% range in several studies.

As healthcare systems continue to grapple with the aftershocks of the pandemic, ongoing research and improved infection control practices are essential. Looking ahead, healthcare professionals must remain alert to the interplay between viral infections and opportunistic fungal diseases, ideally via comprehensive protocols that prioritize both COVID-19 treatment and fungal infection prevention.

With the information procured from this comprehensive study, it is clear that the intersection of candidaemia and COVID-19 remains a critical area for further investigation and immediate action, especially as we navigate the complexities of healthcare in a post-pandemic world.