Candidemia in post-COVID era: increasing incidence of endemic fluconazole-resistant Candida parapsilosis and Candidozyma auris.

OBJECTIVES

To assess the effect of the COVID-19 pandemic on the epidemiology of candidemia.

METHODS

We retrospectively analyzed candidemia episodes diagnosed from 2018 to 2024 in a tertiary university hospital, evaluating incidence trends, species distribution, ward origin, antifungal susceptibility, and antifungal consumption in the context of the COVID-19 pandemic.

RESULTS

Candidemia incidence remained high beyond the COVID-19 pandemic, particularly in intensive care unit. Candida parapsilosis species complex was the predominant pathogen, accounting for 41.4% in the post-COVID era, and exhibited persistently high fluconazole resistance rates of up to 64.3% together with increasing resistance to voriconazole. Increased azole resistance was associated with isolation from intensive care units. Candidozyma auris (Candida auris), first identified in 2022, rapidly became endemic, accounting for 29.5% of isolates in the post-COVID era and exhibiting uniform resistance to fluconazole. Candida albicans (18.5%) ranked as the third most frequently isolated species. Amphotericin B and echinocandins retained excellent in vitro activity, whereas the clinical utility of fluconazole was markedly reduced due to the high prevalence of resistant C. parapsilosis and C. auris.

CONCLUSIONS

The COVID-19 pandemic was associated with a sustained increase in candidemia incidence, major shifts in species distribution, and high fluconazole resistance rates. These findings underline the need for ongoing surveillance and implementation of infection control measures.