Yeast Bloodstream Infections in the COVID-19 Patient: A Multicenter Italian Study (FiCoV Study)

Area of Science:

• Infectious Diseases
• Critical Care Medicine
• Mycology

Background:

• Fungal infections, specifically fungemia, complicate the clinical course of critically ill COVID-19 patients.
• Yeast bloodstream infections (BSIs) represent a significant co-infection, contributing to increased morbidity and mortality in hospitalized COVID-19 patients.

Purpose of the Study:

• To determine the frequency of yeast BSIs in hospitalized COVID-19 patients.
• To identify factors associated with yeast BSIs in this population.
• To analyze the antifungal susceptibility patterns of isolated yeast species.

Main Methods:

• A multicenter Italian observational study (FiCoV) involving 10 hospitals.
• Inclusion of all hospitalized adult COVID-19 patients diagnosed with a yeast BSI.
• Collection of anonymous patient data and antifungal susceptibility testing results.

Main Results:

• Yeast BSI occurred in 1.06% of COVID-19 patients, with significant variation across centers.
• Risk factors included intensive care unit admission (68.6%), age over 60 (73%), corticosteroid therapy (61.8%), and comorbidities (e.g., diabetes 25.3%).
• Candida parapsilosis (49.8%) and Candida albicans (35.2%) were predominant; 72% of C. parapsilosis strains showed fluconazole resistance. The fatality rate for COVID-19 patients with yeast BSI was 45.5% compared to 30.5% without.

Conclusions:

• A high prevalence of Candida BSIs exists in critically ill COVID-19 patients, especially those in intensive care units.
• Fungal co-infection is linked to a substantially higher fatality rate.
• The study highlights the concerning emergence of azole-resistant Candida parapsilosis, necessitating careful monitoring and treatment strategies.