tetano
Editor, Senior Moderator
Open Forum Infect Dis
. 2022 Feb 13;9(4)
fac078.
doi: 10.1093/ofid/ofac078. eCollection 2022 Apr.
Candidemia Among Coronavirus Disease 2019 Patients in Turkey Admitted to Intensive Care Units: A Retrospective Multicenter Study
Amir Arastehfar[SUP] 1 [/SUP], Nevzat Ünal[SUP] 2 [/SUP], Tuğrul Hoşbul[SUP] 3 [/SUP], Muhammed Alper Özarslan[SUP] 4 [/SUP], Ayşe Sultan Karakoyun[SUP] 5 [/SUP], Furkan Polat[SUP] 4 [/SUP], Diego Fuentes[SUP] 6 7 [/SUP], Ramazan Gümral[SUP] 3 [/SUP], Tuba Turunç[SUP] 8 [/SUP], Farnaz Daneshnia[SUP] 1 [/SUP], David S Perlin[SUP] 1 [/SUP], Cornelia Lass-Flörl[SUP] 9 [/SUP], Toni Gabaldón[SUP] 6 7 10 11 [/SUP], Macit Ilkit[SUP] 5 [/SUP], M Hong Nguyen[SUP] 12 [/SUP]
Affiliations
Abstract
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.
Keywords: COVID-19; bacteremia; candidemia; fluconazole resistance; infection control.
. 2022 Feb 13;9(4)
fac078.doi: 10.1093/ofid/ofac078. eCollection 2022 Apr.
Candidemia Among Coronavirus Disease 2019 Patients in Turkey Admitted to Intensive Care Units: A Retrospective Multicenter Study
Amir Arastehfar[SUP] 1 [/SUP], Nevzat Ünal[SUP] 2 [/SUP], Tuğrul Hoşbul[SUP] 3 [/SUP], Muhammed Alper Özarslan[SUP] 4 [/SUP], Ayşe Sultan Karakoyun[SUP] 5 [/SUP], Furkan Polat[SUP] 4 [/SUP], Diego Fuentes[SUP] 6 7 [/SUP], Ramazan Gümral[SUP] 3 [/SUP], Tuba Turunç[SUP] 8 [/SUP], Farnaz Daneshnia[SUP] 1 [/SUP], David S Perlin[SUP] 1 [/SUP], Cornelia Lass-Flörl[SUP] 9 [/SUP], Toni Gabaldón[SUP] 6 7 10 11 [/SUP], Macit Ilkit[SUP] 5 [/SUP], M Hong Nguyen[SUP] 12 [/SUP]
Affiliations
- PMID: 35345665
- PMCID: PMC8903397
- DOI: 10.1093/ofid/ofac078
Abstract
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.
Keywords: COVID-19; bacteremia; candidemia; fluconazole resistance; infection control.