The impact of the COVID-19 on the antifungal consumption and antifungal resistance in Candida species isolated from the blood cultures of critically ill patients in intensive care units

Med Mycol. 2025 Jan 25;63(2):myaf002. doi: 10.1093/mmy/myaf002.

Abstract

Incidence of Candida species increased in critically ill COVID-19 patients in intensive care units. This study aimed to investigate the impact of the COVID-19 pandemic on antifungal consumption and Candida species distribution in bloodstream infections. We observed that a significant increase in non-albicansCandida species cases (P = .005) in 2021 coincided with higher rates of fluconazole resistance (P = .002) and increased minimum inhibitory concentrations for echinocandins (P = .012). Notably, voriconazole consumption and increased MIC levels positively correlated with both Candida albicans and non-albicansCandida species. This study underscores the importance of judicious antifungal use during the COVID-19 pandemic.

Keywords: Candida; COVID-19; antifungal consumption; antifungal resistance; candidemia; invasive candidiasis.

Plain language summary

Incidence of Candida infections increased during the COVID-19 pandemic. This study investigated the impact of COVID-19 on antifungal consumption. An increase in non-albicansCandida species and fluconazole resistance was observed. This study underscores the importance of judicious antifungal use in COVID-19.

MeSH terms

  • Aged
  • Antifungal Agents* / pharmacology
  • Antifungal Agents* / therapeutic use
  • Blood Culture
  • COVID-19* / complications
  • COVID-19* / epidemiology
  • Candida* / classification
  • Candida* / drug effects
  • Candida* / isolation & purification
  • Candidemia* / drug therapy
  • Candidemia* / epidemiology
  • Candidemia* / microbiology
  • Critical Illness
  • Drug Resistance, Fungal*
  • Female
  • Fluconazole / pharmacology
  • Fluconazole / therapeutic use
  • Humans
  • Intensive Care Units
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • SARS-CoV-2
  • Voriconazole / pharmacology
  • Voriconazole / therapeutic use

Substances

  • Antifungal Agents
  • Fluconazole
  • Voriconazole