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. 2024 Jul;29(29):2300661.
doi: 10.2807/1560-7917.ES.2024.29.29.2300661.

Increase in candidemia cases and emergence of fluconazole-resistant Candida parapsilosis and C. auris isolates in a tertiary care academic hospital during the COVID-19 pandemic, Greece, 2020 to 2023

Maria Siopi  1 , Panagiota-Christina Georgiou  1 , Paschalis Paranos  1 , Maria-Ioanna Beredaki  1 , Aikaterini Tarpatzi  1 , Eleni Kalogeropoulou  1 , Sofia Damianidou  1 , Alexandra Vasilakopoulou  1 , Polyxeni Karakosta  1 , Spyros Pournaras  1 , Joseph Meletiadis  1
Affiliations

Increase in candidemia cases and emergence of fluconazole-resistant Candida parapsilosis and C. auris isolates in a tertiary care academic hospital during the COVID-19 pandemic, Greece, 2020 to 2023

Maria Siopi et al. Euro Surveill. 2024 Jul.

Abstract

BackgroundThe COVID-19 pandemic and the emergence of Candida auris have changed the epidemiological landscape of candidaemia worldwide.AimWe compared the epidemiological trends of candidaemia in a Greek tertiary academic hospital before (2009-2018) and during the early COVID-19 (2020-2021) and late COVID-19/early post-pandemic (2022-2023) era.MethodsIncidence rates, species distribution, antifungal susceptibility profile and antifungal consumption were recorded, and one-way ANOVA or Fisher's exact test performed. Species were identified by MALDI-ToF MS, and in vitro susceptibility determined with CLSI M27-Ed4 for C. auris and the EUCAST-E.DEF 7.3.2 for other Candida spp.ResultsIn total, 370 candidaemia episodes were recorded during the COVID-19 pandemic. Infection incidence (2.0 episodes/10,000 hospital bed days before, 3.9 during the early and 5.1 during the late COVID-19 era, p < 0.0001), C. auris (0%, 9% and 33%, p < 0.0001) and fluconazole-resistant C. parapsilosis species complex (SC) (20%, 24% and 33%, p = 0.06) infections increased over time, with the latter not associated with increase in fluconazole/voriconazole consumption. A significant increase over time was observed in fluconazole-resistant isolates regardless of species (8%, 17% and 41%, p < 0.0001). Resistance to amphotericin B or echinocandins was not recorded, with the exception of a single pan-echinocandin-resistant C. auris strain.ConclusionCandidaemia incidence nearly tripled during the COVID-19 era, with C. auris among the major causative agents and increasing fluconazole resistance in C. parapsilosis SC. Almost half of Candida isolates were fluconazole-resistant, underscoring the need for increased awareness and strict implementation of infection control measures.

Keywords: C. auris; Greece; antimicrobial resistance; candidaemia; epidemiology; fluconazole-resistant C. parapsilosis; fungal infections; healthcare-associated infections; infection control; laboratory; laboratory surveillance.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Species distribution of Candida bloodstream isolates and changes in candidaemic episodes (per 1,000 hospital admissions) before the COVID-19 pandemic (2009–2018) [15], and during the early (2020–2021) and late (2022–2023) pandemic era, Attikon University General Hospital of Athens, Greece
Figure 2
Figure 2
Trends of fluconazole-resistant Candida spp. isolates before the COVID-19 pandemic (2009–2018) [15], and in patients during the early (2020–2021) and late (2022–2023) pandemic era, Attikon University General Hospital of Athens, Greece
Figure 3
Figure 3
Consumption trend of antifungal agents before the COVID-19 pandemic (2009–2018) [15], and in patients during the early (2020–2021) and late (2022–2023) pandemic era, Attikon University General Hospital of Athens, Greece
See this image and copyright information in PMC

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