Impact of COVID-19 on candidemia: Risk factors and outcomes in a southeastern US cohort

Candidemia cases increased during the COVID-19 pandemic, likely due to increased critical care interventions. However, the pandemic's impact on candidemia risk factors and outcomes remains understudied. The objective of this study was to evaluate changes in candidemia risk factors and in-hospital mortality before and during the COVID-19 pandemic, stratified by COVID-19 status. We retrospectively analyzed adult candidemia cases (defined by Candida species isolated from blood cultures) at a single center in Albany, Georgia, USA (January 2017-May 2023). Patients were grouped as (1) pre-pandemic, (2) pandemic with COVID-19, and (3) pandemic without COVID-19. Clinical characteristics, risk factors, and in-hospital mortality were compared across groups. Among 89 patients (44% pre-pandemic, 56% pandemic [50% with COVID-19]), comorbidities were highest pre-pandemic (P = .008), though 12% of patients with COVID-19 had none (vs. 0% pre-pandemic, 4% non-COVID-19; P = .01). Candidemia was more often diagnosed in the ICU among the COVID-19 group (92%) compared to pre-pandemic (49%) and non-COVID-19 pandemic groups (44%) (P < .001). Mechanical ventilation (88%) and vascular catheter use (96%) were also higher in the COVID-19 group (P < .001 for both). Glucocorticoid use was more frequent in the COVID-19 group (76%) versus pre-pandemic (18%) and non-COVID-19 pandemic groups (24%) (P = .008). In-hospital mortality was highest in the COVID-19 group (76%) compared to the pre-pandemic (44%) and non-COVID-19 pandemic groups (32%) (P < .001). Patients with COVID-19 had a higher prevalence of risk factors for candidemia and significantly worse clinical outcomes, including increased in-hospital mortality, compared to other groups.