We compared candidemia due to Candida auris and other non-C.auris cases in hospitalized COVID-19 patients over a period of nine months at our institution. Candidemia cases in all admitted patients (with or without COVID-19) from April-December 2020 were identified. Electronic records were accessed to record clinical data of COVID-19 patients with candidemia. For statistical analysis, independent samples Mann-Whitney U test was used for continuous and Fisher's exact test was used for categorical variables.A total of 26 candidemia cases (four C.auris, 22 non-C.auris) in 2438 admitted COVID-19 (10.7 per 1000 admissions) and 59 candidemia cases (six C.auris, 53 non-C.auris) in admitted non-COVID patients (8.2 per 1000 admission) were identified. The proportion of C.auris candidemia in COVID-19 and non-COVID-19 patients was 15.4% and 10% respectively. 4/26 of COVID-19 candidemia patients were aged ≤ 15 years (10 months-15 years). Comparison of C.auris and non-C.auris candidemia cases reveal significant difference in prior antifungal exposure, present in 100% C.auris candidemia versus 27% non-C.auris candidemia patients (p-value 0.014). Although not statistically significant, C.auris candidemia patients had a longer stay in hospital before candidemia (20 vs 9 days), higher isolation rate of multidrug resistant bacteria (100% vs 50%), increased rate of prior colonization of Candida species (50% vs 14%) and lower mean beta-d-glucan levels (48.73 pg/mL vs. 138.146 pg/mL). Both C.auris and non-C.auris COVID-19 patients had similar mortality rate (67% vs 65%). A significant number of critically ill COVID-19 patients developed candidemia in our study highlighting the need for prompt diagnosis and management.
LAY SUMMARY
26 candidemia cases (4 Candida auris;22 non-C.auris) in COVID-19 patients (April-December 2020) are reported from Pakistan. Compared to non-C.auris, C.auris candidemia patients had higher prior antifungal exposure, longer hospital stay, higher MDR bacteria and increased rate of Candida colonization.