Multicentre Surveillance of Species from Blood Cultures during the SARS-CoV-2 Pandemic in Southern Europe (CANCoVEU Project).

: Surveillance of species isolates from blood cultures (BCs) in Europe is considered fragmented, unable to allow the definition of targets of antifungal stewardship recommendations especially during the SARS-CoV-2 pandemic. : We performed a multicentric retrospective study including all consecutive BC isolates from six Southern European tertiary hospitals (1st January 2020 to 31st December 2021). Etiology, antifungal susceptibility patterns, and clinical setting were analyzed and compared. : was the dominant species (45.1%), while was undetected. species positive BC events increased significantly in COVID-19 ICUs in 2021 but decreased in other ICUs. Resistance to azole increased significantly and remained very high in (fluconazole from 0.7% to 4.5%, = 0.03) and complex (fluconazole up to 24.5% and voriconazole up to 8.9%), respectively. Resistance to caspofungin was remarkable in (10%) and (20%), while resistance to at least one echinocandin increased in 2021, especially in complex (from 0.8% to 5.1%, = 0.05). Although no significant differences were observed over the study period, fluconazole and echinocandin resistance increased in COVID-19 ICUs by up to 14% and 5.8%, respectively, but remained undetected in non-intensive COVID-19 wards. : Antifungal stewardship activities aimed at monitoring resistance to echinocandin in and , and against the spread of fluconazole resistant complex isolates are highly desirable. In COVID-19 patients, antifungal resistance was mostly present when the illness had a critical course.