COVID-19 Is a Confounder of Increased Candida Airway Colonisation
Margaux Froidefond1,2, Jacques Sevestre1,2, Hervé Chaudet1,2
1Faculté des Sciences Médicales et Paramédicales, Aix Marseille University, IRD, AP-HM, SSA, VITROME, 13005 Marseille, France.
Abstract:
An increased incidence of invasive fungal infection was reported in SARS-CoV-2-infected patients hospitalised in the intensive care unit. However, the impact of COVID-19 on Candida airway colonisation has not yet been assessed. This study aimed to test the impact of several factors on Candida airway colonisation, including SARS-CoV-2 infection. We conducted a two-pronged monocentric retrospective study. First, we analysed the prevalence of positive yeast culture in respiratory samples obtained from 23 departments of the University Hospital of Marseille between 1 January 2018 and 31 March 2022. We then conducted a case-control study, comparing patients with documented Candida airway colonisation to two control groups. We observed an increase in the prevalence of yeast isolation over the study period. The case-control study included 300 patients. In the multivariate logistic regression, diabetes, mechanical ventilation, length of stay in the hospital, invasive fungal disease, and the use of antibacterials were independently associated with Candida airway colonisation. The association of SARS-CoV-2 infection with an increased risk of Candida airway colonisation is likely to be a consequence of confounding factors. Nevertheless, we found the length of stay in the hospital, mechanical ventilation, diabetes, and the use of antibacterials to be statistically significant independent risk factors of Candida airway colonisation.
Insights
COVID-19 did not directly increase Candida airway colonization. However, factors like diabetes, mechanical ventilation, and longer hospital stays significantly elevate the risk of fungal colonization in patients.
Area of Science:
- Medical Mycology
- Infectious Diseases
- Critical Care Medicine
Background:
- Invasive fungal infections, particularly in intensive care units, have been linked to SARS-CoV-2 (COVID-19) infection.
- The specific impact of COVID-19 on airway colonization by *Candida* species remains largely unassessed.
- Understanding risk factors for *Candida* airway colonization is crucial for patient management in hospital settings.
Purpose of the Study:
- To investigate the influence of various factors, including SARS-CoV-2 infection, on *Candida* airway colonization.
- To identify independent risk factors associated with *Candida* airway colonization in hospitalized patients.
Main Methods:
- A two-pronged, monocentric retrospective study was conducted at the University Hospital of Marseille.
- Prevalence of positive yeast cultures in respiratory samples was analyzed from January 2018 to March 2022.
- A case-control study compared 300 patients with *Candida* airway colonization against two control groups.
Main Results:
- A general increase in yeast isolation prevalence was observed over the study period.
- Multivariate logistic regression identified diabetes, mechanical ventilation, prolonged hospital stay, invasive fungal disease, and antibacterial use as independent risk factors for *Candida* airway colonization.
- SARS-CoV-2 infection was not found to be an independent risk factor, suggesting its association is likely due to confounding variables.
Conclusions:
- Diabetes, mechanical ventilation, extended hospital stays, and antibacterial use are significant independent risk factors for *Candida* airway colonization.
- The direct link between SARS-CoV-2 infection and increased *Candida* airway colonization is likely mediated by these confounding factors.
- These findings highlight the importance of managing underlying conditions and hospital-related factors to prevent fungal colonization.
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