The Impact of COVID-19 on the Epidemiology and Outcomes of Candidemia: A Retrospective Study from a Tertiary Care Center in Lebanon

Aline El Zakhem; Omar Mahmoud; Johnny Zakhour; Sarah B Nahhal; Nour El Ghawi; Nadine Omran; Walaa G El Sheikh; Hani Tamim; Souha S Kanj

doi:10.3390/jof9070769

The Impact of COVID-19 on the Epidemiology and Outcomes of Candidemia: A Retrospective Study from a Tertiary Care Center in Lebanon

J Fungi (Basel). 2023 Jul 21;9(7):769. doi: 10.3390/jof9070769.

Authors

Aline El Zakhem¹, Omar Mahmoud¹, Johnny Zakhour¹, Sarah B Nahhal¹, Nour El Ghawi¹, Nadine Omran¹, Walaa G El Sheikh², Hani Tamim^{2

3}, Souha S Kanj^{1

4}

Affiliations

¹ Division of Infectious Diseases, American University of Beirut Medical Center, Beirut 110236, Lebanon.
² Biostatistics Unit, Clinical Research Institute, American University of Beirut, Beirut 110236, Lebanon.
³ College of Medicine, Alfaisal University, Riyadh 11533, Saudi Arabia.
⁴ Center for Infectious Diseases Research, American University of Beirut, Beirut 110236, Lebanon.

Abstract

Invasive fungal infections, notably candidemia, have been associated with COVID-19. The epidemiology of candidemia has significantly changed during the COVID-19 pandemic. We aim to identify the microbiological profile, resistance rates, and outcomes of COVID-19-associated candidemia (CAC) compared to patients with candidemia not associated with COVID-19. We retrospectively collected data on patients with candidemia admitted to the American University of Beirut Medical Center between 2004 and 2022. We compared the epidemiology of candidemia during and prior to the COVID-19 pandemic. Additionally, we compared the outcomes of critically ill patients with CAC to those with candidemia without COVID-19 from March 2020 till March 2022. Among 245 candidemia episodes, 156 occurred prior to the pandemic and 89 during the pandemic. Of the latter, 39 (43.8%) were CAC, most of which (82%) were reported from intensive care units (ICU). Non-albicans Candida (NAC) spp. were predominant throughout the study period (67.7%). Candida auris infection was the most common cause of NAC spp. in CAC. C. glabrata had decreased susceptibility rates to fluconazole and caspofungin during the pandemic period (46.1% and 38.4%, respectively). The mortality rate in the overall ICU population during the pandemic was 76.6%, much higher than the previously reported candidemia mortality rate observed in studies involving ICU patients. There was no significant difference in 30-day mortality between CAC and non-CAC (75.0% vs. 78.1%; p = 0.76). Performing ophthalmic examination (p = 0.002), CVC removal during the 48 h following the candidemia (p = 0.008) and speciation (p = 0.028) were significantly associated with a lower case-fatality rate. The epidemiology of candidemia has been significantly affected by the COVID-19 pandemic at our center. Rigorous infection control measures and proper antifungal stewardship are essential to combat highly resistant species such as C. auris.

Keywords: Arab world; COVID-19; Candida; Candida auris; EQUAL score; Lebanon; antifungal susceptibility; candidemia; invasive candidiasis; non-albicans Candida.

Grants and funding

This research received no external funding.