El Zakhem Aline, Mahmoud Omar, Zakhour Johnny, Nahhal Sarah B, El Ghawi Nour, Omran Nadine, El Sheikh Walaa G, Tamim Hani, Kanj Souha S
Division of Infectious Diseases, American University of Beirut Medical Center, Beirut 110236, Lebanon.
Biostatistics Unit, Clinical Research Institute, American University of Beirut, Beirut 110236, Lebanon.
J Fungi (Basel). 2023 Jul 21;9(7):769. doi: 10.3390/jof9070769.
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 (NAC) spp. were predominant throughout the study period (67.7%). infection was the most common cause of NAC spp. in CAC. 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%; = 0.76). Performing ophthalmic examination ( = 0.002), CVC removal during the 48 h following the candidemia ( = 0.008) and speciation ( = 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 .
侵袭性真菌感染，尤其是念珠菌血症，与新冠肺炎相关。在新冠肺炎大流行期间，念珠菌血症的流行病学发生了显著变化。我们旨在确定与非新冠肺炎相关念珠菌血症患者相比，新冠肺炎相关念珠菌血症（CAC）的微生物学特征、耐药率和预后情况。我们回顾性收集了2004年至2022年期间在贝鲁特美国大学医学中心住院的念珠菌血症患者的数据。我们比较了新冠肺炎大流行期间和之前念珠菌血症的流行病学情况。此外，我们比较了2020年3月至2022年3月期间重症CAC患者与非新冠肺炎相关念珠菌血症患者的预后情况。在245例念珠菌血症发作中，156例发生在大流行之前，89例发生在大流行期间。在后者中，39例（43.8%）为CAC，其中大部分（82%）报告自重症监护病房（ICU）。在整个研究期间，非白色念珠菌（NAC）属占主导地位（67.7%）。感染是CAC中NAC属最常见的原因。在大流行期间，对氟康唑和卡泊芬净的药敏率有所下降（分别为46.1%和38.4%）。大流行期间，整个ICU人群的死亡率为76.6%，远高于之前在涉及ICU患者的研究中观察到的念珠菌血症死亡率。CAC和非CAC患者的30天死亡率无显著差异（75.0%对78.1%；P = 0.76）。进行眼科检查（P = 0.002）、念珠菌血症后48小时内拔除中心静脉导管（CVC）（P = 0.008）和菌种鉴定（P = 0.028）与较低的病死率显著相关。在我们中心，新冠肺炎大流行对念珠菌血症的流行病学产生了重大影响。严格的感染控制措施和适当的抗真菌管理对于对抗诸如等高度耐药菌种至关重要。
