Candidemia before and after the COVID-19 pandemic: An analysis of risk factors and outcomes in patients with candidemia
Background: An increase in candidemia has been observed throughout the world since the start of the COVID-19 pandemic. Patients with COVID-19 may have different risk factors, clinical presentations, and outcomes compared to patients without COVID-19. Methods: We conducted a retrospective chart revie...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2022-07-01
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| Series: | Antimicrobial Stewardship & Healthcare Epidemiology |
| Online Access: | https://www.cambridge.org/core/product/identifier/S2732494X22002042/type/journal_article |
| _version_ | 1827995871089786880 |
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| author | Nora Colburn Courtney Nichols Mark Lustberg Shandra Day Michael Haden Christina Liscynesky |
| author_facet | Nora Colburn Courtney Nichols Mark Lustberg Shandra Day Michael Haden Christina Liscynesky |
| author_sort | Nora Colburn |
| collection | DOAJ |
| description | Background: An increase in candidemia has been observed throughout the world since the start of the COVID-19 pandemic. Patients with COVID-19 may have different risk factors, clinical presentations, and outcomes compared to patients without COVID-19. Methods: We conducted a retrospective chart review of all inpatients with candidemia at a large, academic medical center from April 30, 2019, to February 19, 2021. The first case of COVID-19 was detected at our institution March 2020 and patients were sorted into pre– versus post–COVID-19 pandemic groups. Data regarding clinical characteristics, risk factors, and outcomes were collected. The rate of candidemia per 10,000 patient days was calculated from January 2013 through February 2021. Results: In total, 202 patients were identified with candidemia: 92 cases were identified before the pandemic and 110 cases were identified after the pandemic began. Moreover, 33 (16.3%) patients were diagnosed with COVID-19 during the admission and 169 (83.7%) did not have COVID-19. Patients with COVID-19 were significantly more likely to be older (median, 64.5 vs 54.8 years; P = .0006) and to have a higher body mass index (32.8 vs 29.1; P = .03) than patients without COVID-19. Patients with COVID-19 were less likely have some of the traditional risk factors (eg, abdominal surgery, total parenteral nutrition, history of injecting drugs) for candidemia compared to patients without COVID-19. Patients with COVID-19 were significantly more likely to require ICU care (97.0% vs 67.5%; P < .001) and to require mechanical ventilation (90.9% vs 53.9%; P < .001), and they had higher mortality at 30 days (66.7% vs 31.4%; P < .001). A multivariate logistic regression model showed that COVID-19 (OR, 2.53; 95% CI, 1.09–5.90) and higher age (OR 1.45, 95% CI, 1.11–1.91) were significant predictors of 30 day mortality. Using a Poisson regression model, the incidence rate ratio for candidemia per month after the start of the COVID-19 pandemic was 2.09 (95% CI, 1.85–2.36; P < .0001) compared to the years prior. Conclusions: Rates of candidemia significantly increased after the start of the COVID-19 pandemic. Patients with candidemia in the post–COVID-19 era tend to have nontraditional risk factors, to be more critically ill, and to have increased mortality compared to patients in the pre–COVID-19 era. COVID-19 and higher age were independent predictors of mortality. More studies are needed to further define risk factors for candidemia in patients with COVID-19. |
| first_indexed | 2024-04-10T05:03:12Z |
| format | Article |
| id | doaj.art-0775d216f57f45c8bd86f25f3e44aae8 |
| institution | Directory Open Access Journal |
| issn | 2732-494X |
| language | English |
| last_indexed | 2024-04-10T05:03:12Z |
| publishDate | 2022-07-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | Antimicrobial Stewardship & Healthcare Epidemiology |
| spelling | doaj.art-0775d216f57f45c8bd86f25f3e44aae82023-03-09T12:28:11ZengCambridge University PressAntimicrobial Stewardship & Healthcare Epidemiology2732-494X2022-07-012s77s7810.1017/ash.2022.204Candidemia before and after the COVID-19 pandemic: An analysis of risk factors and outcomes in patients with candidemiaNora ColburnCourtney NicholsMark LustbergShandra DayMichael HadenChristina LiscyneskyBackground: An increase in candidemia has been observed throughout the world since the start of the COVID-19 pandemic. Patients with COVID-19 may have different risk factors, clinical presentations, and outcomes compared to patients without COVID-19. Methods: We conducted a retrospective chart review of all inpatients with candidemia at a large, academic medical center from April 30, 2019, to February 19, 2021. The first case of COVID-19 was detected at our institution March 2020 and patients were sorted into pre– versus post–COVID-19 pandemic groups. Data regarding clinical characteristics, risk factors, and outcomes were collected. The rate of candidemia per 10,000 patient days was calculated from January 2013 through February 2021. Results: In total, 202 patients were identified with candidemia: 92 cases were identified before the pandemic and 110 cases were identified after the pandemic began. Moreover, 33 (16.3%) patients were diagnosed with COVID-19 during the admission and 169 (83.7%) did not have COVID-19. Patients with COVID-19 were significantly more likely to be older (median, 64.5 vs 54.8 years; P = .0006) and to have a higher body mass index (32.8 vs 29.1; P = .03) than patients without COVID-19. Patients with COVID-19 were less likely have some of the traditional risk factors (eg, abdominal surgery, total parenteral nutrition, history of injecting drugs) for candidemia compared to patients without COVID-19. Patients with COVID-19 were significantly more likely to require ICU care (97.0% vs 67.5%; P < .001) and to require mechanical ventilation (90.9% vs 53.9%; P < .001), and they had higher mortality at 30 days (66.7% vs 31.4%; P < .001). A multivariate logistic regression model showed that COVID-19 (OR, 2.53; 95% CI, 1.09–5.90) and higher age (OR 1.45, 95% CI, 1.11–1.91) were significant predictors of 30 day mortality. Using a Poisson regression model, the incidence rate ratio for candidemia per month after the start of the COVID-19 pandemic was 2.09 (95% CI, 1.85–2.36; P < .0001) compared to the years prior. Conclusions: Rates of candidemia significantly increased after the start of the COVID-19 pandemic. Patients with candidemia in the post–COVID-19 era tend to have nontraditional risk factors, to be more critically ill, and to have increased mortality compared to patients in the pre–COVID-19 era. COVID-19 and higher age were independent predictors of mortality. More studies are needed to further define risk factors for candidemia in patients with COVID-19.https://www.cambridge.org/core/product/identifier/S2732494X22002042/type/journal_article |
| spellingShingle | Nora Colburn Courtney Nichols Mark Lustberg Shandra Day Michael Haden Christina Liscynesky Candidemia before and after the COVID-19 pandemic: An analysis of risk factors and outcomes in patients with candidemia Antimicrobial Stewardship & Healthcare Epidemiology |
| title | Candidemia before and after the COVID-19 pandemic: An analysis of risk factors and outcomes in patients with candidemia |
| title_full | Candidemia before and after the COVID-19 pandemic: An analysis of risk factors and outcomes in patients with candidemia |
| title_fullStr | Candidemia before and after the COVID-19 pandemic: An analysis of risk factors and outcomes in patients with candidemia |
| title_full_unstemmed | Candidemia before and after the COVID-19 pandemic: An analysis of risk factors and outcomes in patients with candidemia |
| title_short | Candidemia before and after the COVID-19 pandemic: An analysis of risk factors and outcomes in patients with candidemia |
| title_sort | candidemia before and after the covid 19 pandemic an analysis of risk factors and outcomes in patients with candidemia |
| url | https://www.cambridge.org/core/product/identifier/S2732494X22002042/type/journal_article |
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