Clinical characteristics and outcomes of patients with candidemia during the COVID-19 pandemic: Insights from experience in the Omicron era

Abstract

BackgroundIn Taiwan, COVID-19 outbreaks caused by the Omicron variant occurred in 2022. We investigated the incidence of candidemia during COVID-19 pandemic and the mortality of candidemia patients with COVID-19 in Taiwan. MethodsThe incidence of candidemia and fluconazole susceptibility of Candida species before (2015 to 2019) and during COVID-19 pandemic (2020 to 2023) at Kaohsiung Chang Gung Memorial Hospital were investigated. The associated factors with mortality in candidemia patients during COVID-19 pandemic were analyzed. Candidemia patients who had COVID-19 within the prior 90 days (case group, n=34) were propensity-score matched for age, ICU admission, and abdominal surgery in a 1:4 ratio with candidemia patients without COVID-19 (control group, n=136). ResultsAge (adjusted odds ratio [AOR] =1.02, 95% CI: 1.01–1.03), ICU stay (AOR =1.84, 95% CI: 1.29–2.62), higher Charlson comorbidity index (AOR =1.08, 95% CI: 1.03–1.13), corticosteroid use (AOR =1.50, 95% CI: 1.04–2.17) were associated with increased risk of mortality; abdominal surgery (AOR =0.47, 95% CI: 0.29–0.74) and infected by C. parapsilosis (AOR =0.61, 95% CI: 0.38–0.98) were associated with decreased risk of mortality. After matching, there was no significant difference in mortality rates between the case and control groups. The incidence of candidemia increased from 196 to 278 patients/100,000 admissions during COVID-19 pandemic, while the causative species of candidemia and fluconazole susceptibility rates were similar. ConclusionWhile the incidence of candidemia increased during COVID-19 pandemic, there was no significant difference in mortality between candidemia patients with and without COVID-19 in the Omicron era.