Epidemiology of invasive candidiasis before and during the COVID-19 pandemic at a hospital in southeastern Brazil.

INTRODUCTION

Invasive candidiasis is an important cause of nosocomial infection and recent studies have shown an increase in the number of cases during the coronavirus disease 2019 (COVID-19) pandemic. The present study aimed to evaluate the epidemiology and incidence of invasive candidiasis before and during the COVID-19 pandemic at a reference tertiary hospital in Brazil.

METHODOLOGY: A retrospective observational study was performed with 148 patients infected with Candida spp.

RESULTS

The incidence of invasive candidiasis was 3.43 cases per 1000 admissions in the pre-pandemic period and 4.54 cases per 1000 admissions in the pandemic period, with a particularly high incidence in the intensive care unit. Compared to the pre-pandemic period, patients presented more frequently with immunosuppression (p = 0.01), sepsis (p = 0.03), and need for mechanical ventilation (p = 0.01) during the pandemic. The prevailing type of Candida spp. infection was candidemia, mostly by C. albicans. Invasive candidiasis was associated with high mortality; 52% of the infected patients died from this disease in the pre-pandemic period, while 62% died in the pandemic period. COVID-19, mechanical ventilation, and sepsis were significantly associated with mortality (p = 0.008, p < 0.001, and p < 0.001 respectively).

CONCLUSIONS

A high incidence of Candida infection was observed at a tertiary general hospital in Brazil between 2018 and 2022. An increase in incidence of Candida infection during the COVID-19 pandemic was associated with a greater number of critical patients. Sepsis, mechanical ventilation, and COVID-19 were related to higher mortality in patients with invasive candidiasis.