| Summary: | The objectives of this study were to investigate the incidence of candidemia, as well as the factors associated with <i>Candida</i> species distribution and fluconazole resistance, among patients admitted to the intensive care unit (ICU) during the COVID-19 pandemic, as compared to two pre-pandemic periods. All patients admitted to the ICU due to COVID-19 from March 2020 to October 2021, as well as during two pre-pandemic periods (2005–2008 and 2012–2015), who developed candidemia, were included. During the COVID-19 study period, the incidence of candidemia was 10.2%, significantly higher compared with 3.2% and 4.2% in the two pre-pandemic periods, respectively. The proportion of non-<i>albicans Candida</i> species increased (from 60.6% to 62.3% and 75.8%, respectively), with a predominance of <i>C. parapsilosis.</i> A marked increase in fluconazole resistance (from 31% to 37.7% and 48.4%, respectively) was also observed. Regarding the total patient population with candidemia (<i>n</i> = 205), fluconazole resistance was independently associated with ICU length of stay (LOS) before candidemia (OR 1.03; CI: 1.01–1.06, <i>p</i> = 0.003), whereas the presence of shock at candidemia onset was associated with <i>C. albicans</i> (OR 6.89; CI: 2.2–25, <i>p</i> = 0.001), and with fluconazole-susceptible species (OR 0.23; CI: 0.07–0.64, <i>p</i> = 0.006). In conclusion, substantial increases in the incidence of candidemia, in non-<i>albicans</i><i>Candida</i> species, and in fluconazole resistance were found in patients admitted to the ICU due to COVID-19, compared to pre-pandemic periods. At candidemia onset, prolonged ICU LOS was associated with fluconazole-resistant and the presence of shock with fluconazole-susceptible species.
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