Impact of the SARS-CoV-2 Pandemic in Candidaemia, Invasive Aspergillosis and Antifungal Consumption in a Tertiary Hospital.

Begoña Fuster Escrivá,Juan Vicente Mulet Bayona,Mercedes Chanzá Aviñó,Pilar Ortega García,Concepción Gimeno Cardona,Carme Salvador García,Nuria Tormo Palop

doi:10.3390/jof7060440

Abstract

In addition to the increase in fungal infections that has been observed in the last few decades, it has been reported that severe clinical COVID-19 can increase the risk of invasive fungal infections. The main objective of this study was to evaluate if there had been an increase in candidaemia and invasive pulmonary aspergillosis (IPA) cases since the onset of the SARS-CoV-2 pandemic. Data were retrospectively collected from April 2019 to March 2021, from patients admitted to Consorcio Hospital General Universitario de Valencia (Spain). A total of 152 candidaemia cases (56 of which were due to Candida auris) and 108 possible IPA cases were detected. A great increase in candidaemia cases was produced during the first and the third epidemic waves of the SARS-CoV-2 pandemic (June 2020, and January 2021, respectively), while an increase in IPA cases was produced during the third wave. The 28-day mortality rates in patients affected by candidaemia and IPA increased in 2020 and 2021. C. auris has displaced the other Candida species, becoming the most isolated Candida species in blood cultures since the onset of the SARS-CoV-2 pandemic. Antifungal consumption increased in 2020 when compared to 2019, especially echinocandins, voriconazole and isavuconazole.

Highlights

SARS-CoV-2, the virus responsible for coronavirus disease 2019 (COVID-19), rapidly spread in 2020 around the world, causing a global health emergency, being officially declared a pandemic by the World Health Organization (WHO) on 11 March 2020 [1].Among the large number of secondary conditions that can be derived from COVID-19, there is an increasing concern about bacterial, fungal and viral co-infections and superinfections occurring in hospitalized patients with COVID-19 [2,3,4,5,6,7]
In addition to the increase in fungal infections that has been observed in the last few decades [8], it has been reported that severe clinical COVID-19 can increase the risk of invasive fungal infections (IFI), such as invasive candidiasis, invasive pulmonary aspergillosis (IPA) or Pneumocystis jirovecii pneumonia [3]
We previously reported a Candida auris outbreak occurring in our hospital, which seemed to have become endemic, and we noted that the onset of the SARS-CoV-2 pandemic had increased the C. auris colonization and candidaemia cases [9,10]

Summary

Introduction

SARS-CoV-2, the virus responsible for coronavirus disease 2019 (COVID-19), rapidly spread in 2020 around the world, causing a global health emergency, being officially declared a pandemic by the World Health Organization (WHO) on 11 March 2020 [1].Among the large number of secondary conditions that can be derived from COVID-19, there is an increasing concern about bacterial, fungal and viral co-infections and superinfections occurring in hospitalized patients with COVID-19 [2,3,4,5,6,7]. In addition to the increase in fungal infections that has been observed in the last few decades [8], it has been reported that severe clinical COVID-19 can increase the risk of invasive fungal infections (IFI), such as invasive candidiasis, invasive pulmonary aspergillosis (IPA) or Pneumocystis jirovecii pneumonia [3]. In this context, we previously reported a Candida auris outbreak occurring in our hospital, which seemed to have become endemic, and we noted that the onset of the SARS-CoV-2 pandemic had increased the C. auris colonization and candidaemia cases [9,10]. Some authors reported new C. auris outbreaks in critically ill COVID-19 patients and alerted that the SARS-CoV-2 pandemic might facilitate the transmission of nosocomial pathogens such as C. auris [11,12,13]

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