Background

Invasive fungal infections (IFI) are increasing in prevalence in recent years. In the last few months, the rise of COVID-19 patients has generated a new escalation in patients presenting opportunistic mycoses, mainly by Aspergillus. Candida infections are not being reported yet.

Objectives

We aimed to determine the prevalence of systemic candidiasis in patients admitted to ICUs due to severe pneumonia secondary to SARS-CoV-2 infection and the existence of possible associated risk factors that led these patients to develop candidiasis.

Patients/methods

We designed a study including patients with a confirmed diagnosis of COVID-19.

Results

The prevalence of systemic candidiasis was 14.4%, and the main isolated species were C. albicans and C. parapsilosis. All patients that were tested positive for Candida spp. stayed longer in the ICU in comparison to patients who tested negative. Patients with candidiasis had higher MuLBSTA score and mortality rates and a worse radiological involvement. In our study, Candida spp. isolates were found in patients that were submitted to: tocilizumab, tocilizumab plus systemic steroids, interferon type 1β and Lopinavir-Ritonavir.

Conclusions

Results suggested a high prevalence of systemic candidiasis in severe COVID-19-associated pneumonia patients. Patients with Candidiasis had the worst clinical outcomes. Treatment with tocilizumab could potentialize the risk to develop systemic candidiasis.

中文翻译：

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念珠菌属 COVID-19 重症肺炎患者合并感染：患病率研究和相关危险因素

背景

近年来，侵袭性真菌感染 (IFI) 的患病率正在增加。在过去的几个月里，COVID-19 患者的增加导致出现机会性真菌病（主要由曲霉菌引起）的患者出现新的升级。尚未报告念珠菌感染。

目标

我们的目的是确定因 SARS-CoV-2 感染继发重症肺炎而入住 ICU 的患者中全身性念珠菌病的患病率，以及是否存在导致这些患者发展为念珠菌病的可能相关风险因素。

患者/方法

我们设计了一项研究，包括确诊为 COVID-19 的患者。

结果

全身性念珠菌病患病率为14.4%，主要分离菌种为白色念珠菌和近平滑念珠菌。所有被检测为念珠菌属阳性的患者。与检测呈阴性的患者相比，他们在 ICU 的停留时间更长。念珠菌病患者的 MuLBSTA 评分和死亡率较高，放射学受累较差。在我们的研究中，念珠菌属。在接受以下治疗的患者中发现分离株：托珠单抗、托珠单抗加全身性类固醇、1β 型干扰素和洛匹那韦-利托那韦。

结论

结果表明，在严重的 COVID-19 相关肺炎患者中，系统性念珠菌病的患病率很高。念珠菌病患者的临床结果最差。使用托珠单抗治疗可能会增加患全身性念珠菌病的风险。