The Landscape of Candidemia During the Coronavirus Disease 2019 (COVID-19) Pandemic
Open accessAbstract
Background: The COVID-19 pandemic has resulted in unprecedented healthcare challenges, and COVID-19 has been linked to secondary infections. Candidemia, a fungal healthcare-associated infection, has been described in patients hospitalized with severe COVID-19. However, studies of candidemia and COVID-19 coinfection have been limited in sample size and geographic scope. We assessed differences in patients with candidemia with and without a COVID-19 diagnosis. Methods: We conducted a case-level analysis using population-based candidemia surveillance data collected through the Centers for Disease Control and Prevention’s Emerging Infections Program during April–August 2020 to compare characteristics of candidemia patients with and without a positive test for COVID-19 in the 30 days before their Candida culture using chi-square or Fisher’s exact tests. Results: Of the 251 candidemia patients included, 64 (25.5%) were positive for SARS-CoV-2. Liver disease, solid-organ malignancies, and prior surgeries were each >3 times more common in patients without COVID-19 coinfection, whereas intensive care unit–level care, mechanical ventilation, having a central venous catheter, and receipt of corticosteroids and immunosuppressants were each >1.3 times more common in patients with COVID-19. All-cause in-hospital fatality was 2 times higher among those with COVID-19 (62.5%) than without (32.1%). Conclusions: One-quarter of candidemia patients had COVID-19. These patients were less likely to have certain underlying conditions and recent surgery commonly associated with candidemia and more likely to have acute risk factors linked to COVID-19 care, including immunosuppressive medications. Given the high mortality, it is important for clinicians to remain vigilant and take proactive measures to prevent candidemia in patients with COVID-19.
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Candidemia in patients with COVID-19 but no other underlying comorbidities likely resulted from healthcare-related exposures related to severe COVID-19 infection.
“Candidemia in these patients with COVID-19 but no other underlying comorbidities likely resulted from healthcare-related exposures related to severe COVID-19 infection.41”
From Epidemiology of Invasive Candidiasis (2024) · cites this paper as [41]
The Discussion says candidemia in patients with COVID-19 likely resulted from healthcare exposures associated with severe disease and its medical management. But it says these patients often lacked certain common risk factors and were less likely to have particular underlying conditions—not that they had no other comorbidities. (LLM, conf=0.86)
Experimental — accuracy not yet measuredChanges to healthcare systems during the COVID-19 pandemic and the high acuity of care required for patients with COVID-19 likely contributed to the increased risk of invasive candidiasis among patients with COVID-19.
“Changes to healthcare systems during the COVID-19 pandemic (eg, lapses in infection control practices, increased antimicrobial prescribing) and the high acuity of care required for patients with COVID-19 infections (eg, invasive devices, long lengths of stay), likely contributed to the increased risk of IC among patients with COVID-19.41,42”
From Epidemiology of Invasive Candidiasis (2024) · cites this paper as [41]
The Discussion (page not provided) says that healthcare practices associated with severe COVID-19 and prolonged critical care were likely major contributors to candidemia. The paper also notes greater exposure to antibacterial medications and indwelling devices, but it does not establish lapses in infection control or increased antimicrobial prescribing as contributors; it says the impact of pandemic-related changes in healthcare delivery and infection control was beyond its scope. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe proportion of C. glabrata has increased particularly in the United States, Australia, and Northern Europe.
“The proportion of C. glabrata has increased particularly in the US, Australia, and Northern Europe.25,40,41,55,61”
From Epidemiology of Invasive Candidiasis (2024) · cites this paper as [41]
Table 4 (Historical Comparison; page unavailable) shows a small increase in the proportion of C. glabrata cases in the study’s US cohorts, from 30.3% before the pandemic to 31.5% during it. The paper does not report corresponding trends for Australia or Northern Europe, or establish that the increase was particularly pronounced in those regions. (LLM, conf=0.78)
Experimental — accuracy not yet measuredThese findings might reflect the effects of the COVID-19 pandemic because patients with COVID-19-associated infections were more likely to be critically ill and have worse outcomes compared with those without COVID-19.
“These findings might reflect the effects of the COVID-19 pandemic during this period because patients with COVID-19–associated infections were more likely to be critically ill and have worse outcomes compared with those without COVID-19 (23).”
From Population-Based Active Surveillance for Culture-Confirmed Candidemia — 10 Sites, United States, 2017–2021 (2025) · cites this paper as [23]
The Discussion reports that patients with both COVID-19 and candidemia more often received ICU-level care and had approximately twice the case fatality rate of candidemia patients without COVID-19. The source supports the comparison for candidemia, but the citing sentence's broader phrase “COVID-19–associated infections” is not established for other infections. (LLM, conf=0.85)
Experimental — accuracy not yet measuredThe increase in older adults likely reflects the occurrence of COVID-19-associated candidemia cases during this time frame because severe COVID-19 more often affects older adults.
“This finding likely reflects the occurrence of COVID-19–associated candidemia cases during this time frame because severe COVID-19 more often affects older adults (23).”
From Population-Based Active Surveillance for Culture-Confirmed Candidemia — 10 Sites, United States, 2017–2021 (2025) · cites this paper as [23]
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- Authors
- Seagle, E. E., Jackson, B. R., Lockhart, S. R., Georgacopoulos, O., Nunnally, N. S., Roland, J., Barter, D. M., Johnston, H. L., Czaja, C. A., Kayalioglu, H., Clogher, P., Revis, A., Farley, M. M., Harrison, L. H., Davis, S. S., Phipps, E. C., Tesini, B. L., Schaffner, W., Markus, T. M., & Lyman, M. M.
- Affiliations
- Centers for Disease Control and Prevention (US)
- California Emerging Infections Program, Oakland, California, USA
- Colorado Department of Public Health and Environment (US)
- Yale University (US)
- Atlanta Research and Education Foundation (US)
- Emory University (US)
- Johns Hopkins University (US)
- University of New Mexico (US)
- University of Rochester Medicine (US)
- Vanderbilt University (US)
- Corresponding author
- Seagle, Emma E
- ORCID
- Venue
- Clinical Infectious Diseases
- Publisher
- Oxford University Press (OUP)
- Published
- 2021-06-18
- Volume
- 74
- Issue
- 5
- Pages
- 802-811
- ISSN
- 1058-4838 (ISSN-L)
- 1537-6591
- OpenAlex
- W3170294721
- Semantic Scholar
- e4c6b424437dbe4e0bd1bbcd998f4fc732545444
- Cited by
- 141
- References
- 25
- Citations by year
- 2026: 8 · 2025: 27 · 2024: 23 · 2023: 41 · 2022: 36 · 2021: 6
- FWCI
- 8.41
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- public-domain
- Locations
- Clinical Infectious Diseases (publishedVersion, public-domain)
- PubMed (publishedVersion)
- Funders
- Centers for Disease Control and Prevention (CDC-RFA-CK17-1701)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Antifungal resistance and susceptibility
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Oncology › COVID-19 and healthcare impacts
- Keywords
- candidemia, COVID-19 pandemic, SARS-CoV-2 coinfection, fungemia, nosocomial infections, immunosuppression, corticosteroids, mechanical ventilation, intensive care, central venous catheters, in-hospital mortality, risk factors
- MeSH terms
- COVID-19, SARS-CoV-2, COVID-19 Testing, Humans, Candidemia, Pandemics
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