Candidemia during the COVID-19 pandemic in a Brazilian tertiary care hospital: comparison of episodes with and without COVID-19

The epidemiology of candidemia changed during the COVID-19 pandemic, but direct comparisons of episodes with and without coronavirus disease 2019 (COVID-19) remain limited. We performed a retrospective cohort study of consecutive adult patients with candidemia diagnosed from February 2020 through February 2023 at a Brazilian tertiary-care teaching hospital. Demographic, clinical, microbiological, treatment, and outcome variables were compared according to COVID-19 status, and predictors of 30-day mortality were evaluated among treated patients. Among 106 episodes in 103 patients, 36 (34.0%) occurred in patients with COVID-19. The overall incidence was 4.41 episodes per 1000 admissions (95% confidence interval [CI], 3.61-5.33), and the incidence among COVID-19 admissions was 20.97 per 1000 (95% CI, 14.69-29.03). Episodes with COVID-19 were associated with intensive care, mechanical ventilation, corticosteroid exposure, higher Acute Physiology and Chronic Health Evaluation II (APACHE II) scores, hypotension, and vasopressor use. Thirty-day survival was lower with COVID-19 (19.4% vs 48.6%; P = .003). Among treated episodes, APACHE II score and vasopressor use were independently associated with 30-day mortality. Candidemia associated with COVID-19 occurred in a setting of substantially greater acute illness severity, and severity markers rather than COVID-19 itself appeared to drive excess mortality.