Severe Candida infections in critically ill patients with COVID-19

Despoina Koulenti; Marios Karvouniaris; Elisabeth Paramythiotou; Nikolaos Koliakos; Nikolaos Markou; Paschalis Paranos; Joseph Meletiadis; Stijn Blot

doi:10.1016/j.jointm.2023.07.005

Severe Candida infections in critically ill patients with COVID-19

J Intensive Med. 2023 Sep 2;3(4):291-297. doi: 10.1016/j.jointm.2023.07.005. eCollection 2023 Oct 31.

Authors

Despoina Koulenti^{1

2}, Marios Karvouniaris³, Elisabeth Paramythiotou¹, Nikolaos Koliakos¹, Nikolaos Markou⁴, Paschalis Paranos⁵, Joseph Meletiadis⁵, Stijn Blot^{2

6}

Affiliations

¹ Second Critical Care Department, Attikon University Hospital, Athens, Greece.
² UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia.
³ Intensive Care Unit, ACHEPA University Hospital, Thessaloniki, Greece.
⁴ ICU of Latseio Burns Centre, General Hospital of Elefsis 'Thriasio', Athens, Greece.
⁵ Clinical Microbiology Laboratory, Medical School, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece.
⁶ Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium.

Abstract

The frequency of co-infections with bacterial or fungal pathogens has constantly increased among critically ill patients with coronavirus disease 2019 (COVID-19) during the pandemic. Candidemia was the most frequently reported invasive fungal co-infection. The onset of candidemia in COVID-19 patients was often delayed compared to non-COVID-19 patients. Additionally, Candida invasive infections in COVID-19 patients were more often linked to invasive procedures (e.g., invasive mechanical ventilation or renal replacement therapy) during the intensive care stay and the severity of illness rather than more "classic" risk factors present in patients without COVID-19 (e.g., underlying diseases and prior hospitalization). Moreover, apart from the increased incidence of candidemia during the pandemic, a worrying rise in fluconazole-resistant strains was reported, including a rise in the multidrug-resistant Candida auris. Regarding outcomes, the development of invasive Candida co-infection had a negative impact, increasing morbidity and mortality compared to non-co-infected COVID-19 patients. In this narrative review, we present and critically discuss information on the diagnosis and management of invasive fungal infections caused by Candida spp. in critically ill COVID-19 patients.

Keywords: Antifungals; COVID-19; Candida auris; Candida spp.; Candidiasis; Critical illness.

Publication types

Review