Emma E Seagle1,2, Brendan R Jackson2, Shawn R Lockhart2, Ourania Georgacopoulos2, Natalie S Nunnally2, Jeremy Roland3, Devra M Barter4, Helen L Johnston4, Christopher A Czaja4, Hazal Kayalioglu5, Paula Clogher5, Andrew Revis6,7,8, Monica M Farley6,9, Lee H Harrison10, Sarah Shrum Davis11, Erin C Phipps11, Brenda L Tesini12, William Schaffner13, Tiffanie M Markus13, Meghan M Lyman2. 1. ASRT, Inc, Atlanta, Georgia, USA. 2. Mycotic Disease Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, USA. 3. California Emerging Infections Program, Oakland, California, USA. 4. Colorado Department of Public Health and Environment, Denver, Colorado, USA. 5. Connecticut Emerging Infections Program, Yale School of Public Health, New Haven, Connecticut, USA. 6. Atlanta VA Medical Center, Atlanta, Georgia, USA. 7. Foundation for Atlanta Veterans Education and Research, Atlanta, Georgia, USA. 8. Georgia Emerging Infections Program, Atlanta, Georgia, USA. 9. Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA. 10. Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA. 11. New Mexico Emerging Infections Program, University of New Mexico, Albuquerque, New Mexico,USA. 12. University of Rochester School of Medicine, Rochester, New York, USA. 13. Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Abstract
BACKGROUND: The COVID-19 pandemic has resulted in unprecedented healthcare challenges, and COVID-19 has been linked to secondary infections. Candidemia, a fungal healthcare-associated infection, has been described in patients hospitalized with severe COVID-19. However, studies of candidemia and COVID-19 coinfection have been limited in sample size and geographic scope. We assessed differences in patients with candidemia with and without a COVID-19 diagnosis. METHODS: We conducted a case-level analysis using population-based candidemia surveillance data collected through the Centers for Disease Control and Prevention's Emerging Infections Program during April-August 2020 to compare characteristics of candidemia patients with and without a positive test for COVID-19 in the 30 days before their Candida culture using chi-square or Fisher's exact tests. RESULTS: Of the 251 candidemia patients included, 64 (25.5%) were positive for SARS-CoV-2. Liver disease, solid-organ malignancies, and prior surgeries were each >3 times more common in patients without COVID-19 coinfection, whereas intensive care unit-level care, mechanical ventilation, having a central venous catheter, and receipt of corticosteroids and immunosuppressants were each >1.3 times more common in patients with COVID-19. All-cause in-hospital fatality was 2 times higher among those with COVID-19 (62.5%) than without (32.1%). CONCLUSIONS: One-quarter of candidemia patients had COVID-19. These patients were less likely to have certain underlying conditions and recent surgery commonly associated with candidemia and more likely to have acute risk factors linked to COVID-19 care, including immunosuppressive medications. Given the high mortality, it is important for clinicians to remain vigilant and take proactive measures to prevent candidemia in patients with COVID-19. Published by Oxford University Press for the Infectious Diseases Society of America 2021.
BACKGROUND: The COVID-19 pandemic has resulted in unprecedented healthcare challenges, and COVID-19 has been linked to secondary infections. Candidemia, a fungal healthcare-associated infection, has been described in patients hospitalized with severe COVID-19. However, studies of candidemia and COVID-19 coinfection have been limited in sample size and geographic scope. We assessed differences in patients with candidemia with and without a COVID-19 diagnosis. METHODS: We conducted a case-level analysis using population-based candidemia surveillance data collected through the Centers for Disease Control and Prevention's Emerging Infections Program during April-August 2020 to compare characteristics of candidemia patients with and without a positive test for COVID-19 in the 30 days before their Candida culture using chi-square or Fisher's exact tests. RESULTS: Of the 251 candidemia patients included, 64 (25.5%) were positive for SARS-CoV-2. Liver disease, solid-organ malignancies, and prior surgeries were each >3 times more common in patients without COVID-19 coinfection, whereas intensive care unit-level care, mechanical ventilation, having a central venous catheter, and receipt of corticosteroids and immunosuppressants were each >1.3 times more common in patients with COVID-19. All-cause in-hospital fatality was 2 times higher among those with COVID-19 (62.5%) than without (32.1%). CONCLUSIONS: One-quarter of candidemia patients had COVID-19. These patients were less likely to have certain underlying conditions and recent surgery commonly associated with candidemia and more likely to have acute risk factors linked to COVID-19 care, including immunosuppressive medications. Given the high mortality, it is important for clinicians to remain vigilant and take proactive measures to prevent candidemia in patients with COVID-19. Published by Oxford University Press for the Infectious Diseases Society of America 2021.
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