Comparison of clinical characteristics and outcomes in candidaemia patients with and without COVID-19: a multicentre retrospective study

Background: Invasive fungal infections have been reported as complications with significant mortality and morbidity in patients hospitalized with COVID-19. This study aimed to evaluate the clinical characteristics and outcomes of candidaemia patients with COVID-19 and to investigate the association between COVID-19 and mortality in candidaemia patients.

Methods: This retrospective study included candidaemia patients aged 18 years or older admitted to four university-affiliated tertiary hospitals in South Korea between January 1, 2020, and December 31, 2022. The COVID-19 group comprised patients diagnosed with COVID-19 before the onset of candidaemia. Clinical features and outcomes were compared between the COVID-19 and non-COVID-19 groups. Multivariate logistic regression analyses were performed to identify risk factors related to 30-day mortality.

Results: Of the 355 patients diagnosed with candidaemia, 39 (11.0%) had a prior diagnosis of COVID-19. The COVID-19 group exhibited greater rates of systemic corticosteroid use (20.5% vs. 8.9%, p = 0.042), central venous catheter use (74.4% vs. 57.3%, p = 0.041), and mechanical ventilation (53.8% vs. 31.6%, p = 0.006) before the onset of candidaemia. The COVID-19 group had a greater rate of septic shock at the onset of candidaemia (61.5% vs. 32.0%, p < 0.0001) and a greater 30-day mortality rate (69.2% vs. 50.9%, p = 0.031). K‒M survival analysis revealed that patients in the COVID-19 group had a lower 30-day survival rate than did those without COVID-19 (p = 0.003 by log-rank test). However, in multivariate logistic regression analysis, COVID-19 did not significantly impact 30-day mortality.

Conclusions: According to multivariate logistic regression analysis, COVID-19 was not an independent risk factor for mortality. However, candidaemia patients with a prior COVID-19 diagnosis were more likely to exhibit critical conditions such as mechanical ventilation and experience poor outcomes. Therefore, clinicians need to monitor and prevent candidaemia in critically ill patients with COVID-19.