Antibiotic Use: A Modifiable Factor to Avoid Candidemia in Critically Ill Patients with COVID-19

Author(s): Viviane de Macedo, Ana Carolina do Rocio da Trindade Areco, Elizabeth Amann Simões, Liete Antosz Lopes Maia, Nayane Hiba Fuga, Nicolle Gabriela de Oliveira

Background and Purpose: Secondary fungal infections, such as Candidemia, are often identified as a severe complication of COVID-19 in Intensive Care Units (ICUs), leading probably to a worst prognosis. Therefore, the objective of this study was to identify the risk factors of candidemia in critical ill COVID-19 patients hospitalized in ICU.

Materials and Methods: A retrospective and case control of patients with severe COVID-19 hospitalized in ICUs was performed at two hospitals in Curitiba, from March 2020 to January 2022. The case group consisted of patients with severe COVID-19 and positive blood culture for any Candida during their hospitalization in ICU. The control group consisted of patients also with severe COVID-19 hospitalized in ICU but without candidemia and any positive microbiological culture. Epidemiological data, signs and symptoms related to COVID-19, comorbidities, risk factors for Candidemia, microbiological cultures, laboratorial and radiologic exams were extracted from electronic medical records.

Results: A total of 81 patients with severe COVID-19, 27 were cases and 54 controls were enrolled. Independent risk factors for candidemia were time of hospitalization at ICU (OR = 1.31; IC 95% 1.08 - 1.60; p = 0.006) and number of antibiotics used (increased in almost 80% this risk - OR = 1.78; IC 95% 1.06 - 3.0; p = 0.02). Candida albicans (44%) was the most frequent causative agent.

Conclusion: Among the independent risk factors related to candidemia in this study, the control over the use of antibiotics is the only modifiable factor, consequently, it can be an important tool for preventing candidemia.