Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2024 Oct;67(10):e13798.
doi: 10.1111/myc.13798.

Candidemia Following Severe COVID-19 in Hospitalised and Critical Ill Patients: A Systematic Review and Meta-Analysis

Karan Srisurapanont  1 , Bhoowit Lerttiendamrong  2 , Tanaporn Meejun  1 , Jaedvara Thanakitcharu  3 , Kasama Manothummetha  4 , Achitpol Thongkam  5 , Nipat Chuleerarux  6 , Anawin Sanguankeo  7 , Lucy X Li  4 , Surachai Leksuwankun  8   9 , Nattapong Langsiri  3 , Pattama Torvorapanit  8   9 , Navaporn Worasilchai  10 , Rongpong Plongla  8 , Chatphatai Moonla  8   11 , Saman Nematollahi  12 , Olivia S Kates  4 , Nitipong Permpalung  4   5
Affiliations
Meta-Analysis

Candidemia Following Severe COVID-19 in Hospitalised and Critical Ill Patients: A Systematic Review and Meta-Analysis

Karan Srisurapanont et al. Mycoses. 2024 Oct.

Abstract

Rationale: The epidemiology and clinical impact of COVID-19-associated candidemia (CAC) remained uncertain, leaving gaps in understanding its prevalence, risk factors and outcomes.

Methods: A systematic review and meta-analysis were conducted by searching PubMed, Embase and Scopus for reports of CAC prevalence, risk factors and clinical outcomes up to June 18, 2024. The generalised linear mixed model was employed to determine the prevalence and 95% confidence intervals (CIs). The risk factors and clinical outcomes were compared between patients with and without CAC using the inverse variance method.

Results: From 81 studies encompassing 29 countries and involving 351,268 patients, the global prevalence of CAC was 4.33% (95% Cl, 3.16%-5.90%) in intensive care unit (ICU) patients. In ICUs, the pooled prevalence of CAC in high-income countries was significantly higher than that of lower-middle-income countries (5.99% [95% Cl, 4.24%-8.40%] vs. 2.23% [95% Cl, 1.06%-4.61%], p = 0.02). Resistant Candida species, including C. auris, C. glabrata (Nakaseomyces glabratus) and C. krusei (Pichia kudriavzveii), constituted 2% of ICU cases. The mortality rate for CAC was 68.40% (95% Cl, 61.86%-74.28%) among ICU patients. Several risk factors were associated with CAC, including antibiotic use, central venous catheter placement, dialysis, mechanical ventilation, tocilizumab, extracorporeal membrane oxygenation and total parenteral nutrition. Notably, the pooled odds ratio of tocilizumab was 2.59 (95% CI, 1.44-4.65).

Conclusions: The prevalence of CAC is substantial in the ICU setting, particularly in high-income countries. Several risk factors associated with CAC were identified, including several that are modifiable, offering the opportunity to mitigate the risk of CAC.

Keywords: COVID‐19; SARS‐CoV‐2; candidemia; candidiasis; prevalence.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest

The authors declare no conflicts of interest.

Figures

FIGURE 1 |
FIGURE 1 |
PRISMA flow diagram.
FIGURE 2 |
FIGURE 2 |
The global prevalence of candidemia in hospitalized patients with COVID-19.
FIGURE 3 |
FIGURE 3 |
Forest plot of risk factors for CAC. CAC = COVID-19-associated candidemia; CI = confidence interval; GRADE = Grading of Recommendations Assessment, Development and Evaluation certainty of evidence; OR = odds ratio.
FIGURE 4 |
FIGURE 4 |
Forest plot of all-cause mortality (A), length of hospitalisation (B) and duration of ICU stay (C) in patients with CAC versus patients without CAC. CAC = COVID-19 associated candidemia; CI = confidence interval; ICU = intensive care unit; MD = mean difference; OR = odds ratio; SD = standard deviation.
See this image and copyright information in PMC

References

    1. Baddley JW, Thompson GR, Chen SC-A, et al. , “Coronavirus Disease 2019—Associated Invasive Fungal Infection,” Open Forum Infectious Diseases 8 (2021): ofab510. - PMC - PubMed
    1. Hoenigl M, Seidel D, Sprute R, et al. , “COVID-19-Associated Fungal Infections,” Nature Microbiology 7 (2022): 1127–1140. - PMC - PubMed
    1. Guo F, Yang Y, Kang Y, et al. , “Invasive Candidiasis in Intensive Care Units in China: A Multicentre Prospective Observational Study,” Journal of Antimicrobial Chemotherapy 68 (2013): 1660–1668. - PubMed
    1. Vincent J-L, Sakr Y, Singer M, et al. , “Prevalence and Outcomes of Infection Among Patients in Intensive Care Units in 2017,” JAMA 323 (2020): 1478–1487. - PMC - PubMed
    1. Arastehfar A, Carvalho A, Nguyen MH, et al. , “COVID-19-Associated Candidiasis (CAC): An Underestimated Complication in the Absence of Immunological Predispositions?,” Journal of Fungi 6 (2020): 211. - PMC - PubMed

Substances

LinkOut - more resources