Invasive Candidiasis in Adult Patients with COVID-19: Results of a Multicenter Study in St. Petersburg, Russia

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.

Keywords: COVID-19; Candida; SARS-CoV-2; acute respiratory distress syndrome; candidiasis; fungal; mycoses; yeast.

Figure 1

Frequency of comorbidities in the COVID-IC and COVID without IC groups (* p < 0.0001). HIV—human immunodeficiency virus; COPD—chronic obstructive pulmonary disease.

Figure 2

Risk factors for COVID-IC (* OR > 1).

Figure 3

Clinical manifestations of COVID-IC.

Figure 4

Antifungal therapy in the study and control groups.

Figure 5

The influence of various factors on survival rate of patients with COVID-IC: (A) bronchial colonization by fungi of the genus Candida; (B) C. auris and non-C. auris infection; (C) concomitant bacteremia; (D) hemodialysis; (E) empirical therapy; (F) use of echinocandin; (G) change of central venous catheter; (H) initiation of the antifungal therapy.

Figure 5

The influence of various factors on survival rate of patients with COVID-IC: (A) bronchial colonization by fungi of the genus Candida; (B) C. auris and non-C. auris infection; (C) concomitant bacteremia; (D) hemodialysis; (E) empirical therapy; (F) use of echinocandin; (G) change of central venous catheter; (H) initiation of the antifungal therapy.