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Opportunistic Candida Infections in Critical COVID-19 Patients

Mıne Altinkaya Çavuş
Mıne Altinkaya Çavuş
 e 
Hafıze Sav
Hafıze Sav
   | 24 set 2022
Polish Journal of Microbiology's Cover Image
INFORMAZIONI SU QUESTO ARTICOLO
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Article Category: Original Paper
Pubblicato online: 24 set 2022
Pagine: 411 - 419
Ricevuto: 23 mag 2022
Accettato: 19 lug 2022
DOI: https://doi.org/10.33073/pjm-2022-036
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© 2022 Mine Altınkaya Çavuş and Hafize Sav, published by Sciendo
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Fig. 1

Antifungal (AF) use/mortality graph.
Antifungal (AF) use/mortality graph.

Univariate and multiple binary logistic regression analysis in identifying candidemia in Covid-19 patients.

Variable Univariate Multiple
OR (95% CI) p OR (95% CI) p
Gender (female/male) 2.17 (1.07–4.41) 0.032 – –
Age (year) 1.01 (0.99–1.04) 0.269 – –
APACHE II score 0.97 (0.93–1.02) 0.181 – –
SOFA score 0.93 (0.83–1.05) 0.224 – –
Hospital stay (day) 1.04 (1.02–1.07) 0.002 – –
ICU stay (day) 1.05 (1.02–1.09) 0.002 1.06 (1.01–1.11) 0.025
Comorbidities 5.70 (2.55–12.74) < 0.001 6.94 (2.01–23.90) 0.002
DM 1.07 (0.50–2.28) 0.858 – –
HT 1.47 (0.71–3.05) 0.299 – –
COPD 3.94 (1.08–14.43) 0.039 – –
CAD 2.56 (1.05–6.25) 0.039 – –
Goitre 4.67 (0.55–39.89) 0.159 – –
Neurological disease 4.52 (0.96–21.24) 0.056 – –
CKF/AKF 1.86 (0.67–5.18) 0.235 – –
Intubation 2.90 (1.43–5.88) 0.003 – –
Central Catheter 8.33 (3.36–20.65) < 0.001 – –
BSA 93.75 (25.09–350.24) < 0.001 90.68 (21.84–376.53) < 0.001
Corticosteroid 4.73 (2.24–9.99) < 0.001 – –

Antifungal results against Candida species, reproduced in blood.

VRC μg/ml FLC μg/ml CAS μg/ml AMB μg/ml
Species GM MIC50 MIC90 GM MIC50 MIC90 GM MIC50 MIC90 GM MIC50 MIC90
C. albicans (n = 42) 0.42 0.25 0.75 2.42 2 4 0.74 0.75 1 0.59 0.25 1.5
C. parapsilosis (n = 13) 0.39 0.25 0.5 4.07 4 8 1.46 1 2 0.84 0.75 1.5
C. glabrata (n = 7) 0.42 0.47 0.5 22.5 16 48 1.02 1.5 1.5 0.53 0.5 0.75
C. tropicalis (n = 9) 0.35 0.38 0.5 3.22 2 4 0.75 0.5 2 0.91 0.38 2
C. krusei (n = 3) 0.21 0.25 0.38 74.6 64 128 0.75 0.75 1 0.59 0.75 1

Comparison of the demographic and clinical characteristics among the study groups.

Variable Groups p†
Group 1 (n = 78) Group 2 (n = 189) Group 3 (n = 57)
Gender (male) 54 (69.2)a 87 (46)b 29 (50.9)b 0.002
Age (year) 71.33 ± 13.67ab 73.42 ± 11.34a 68.51 ± 15.74b 0.035
APACHE II score 12 (7–19)   12 (7–19) 14 (9–19) 0.485
SOFA score 4 (2–6)    4 (2–6)   4 (3–6) 0.334
Hospital stay (day) 27 (18–43)a 22 (15–32)b 18 (13–26)b < 0.001
ICU stay (day) 19 (10–27)a 14 (8–22)ab 10 (7–15)b < 0.001
PCR (positive) 50 (64.1) 128 (67.7) 36(63.1) 0.889
Comorbidities 66 (84.6)a 162 (85.7)a 28(49.1)b < 0.001
DM 23 (29.4)   70 (37) 16(28) 0.305
HT 30 (38.4)ab 97( 49.7)a 17 (29.8)b 0.008
COPD 14 (17.9)a 35 (18.5)a 3 (5.2)b 0.049
CAD 23 (29.4)   40 (21.1)   8 (14) 0.093
Malignancy 10 (12.8)a 15 (7.9)a 0 (0.0)b 0.022
Goitre   6 (7.7)a 2 (1.0)b 1 (1.7)ab 0.010
Kidney transplantation   0 (0.0)    2 (1.0)   0 (0.0) 0.487
Immunological disease   3 (3.8)    2(1.0)   0 (0.0) 0.142
Neurological disease 13 (16.6)a 30 (15.8)a 2 (3.5)b 0.044
CKF/AKF 14 (17.9)   26 (13.7)   6 (10.5) 0.226
Mortality 54 (69.2) 133 (60.4) 33 (57.8) 0.208
Intubation 49 (62.8)a 107 (85.2)a 21 (36.8)b 0.008
Central Catheter 42 (53.9)a 58 (30.7)b 7 (12.2)c < 0.001
Juguler 13 (30.9)   18 (31.0)   4 (57.1) 0.139
Femoral 23 (54.7) 31 (53.4)   2 (28.5) < 0.001
Dialysis   6 (14.2)    9 (15.5)   1 (14.2) 0.286
BSA 75 (96.1)a 178 (94.1)a 12 (21.0)b < 0.001
Corticosteroid 49 (62.8)a 142 (75.1)b 15 (26.3)c < 0.001
IL-6 receptor inhibitors   7 (9.0)    7 (3.7)   3 (5.2) 0.214
TPN 24 (30.8)a 59 (31.2)a 5 (8.7)b 0.003
AF 34 (43.5)   95 (50.2) – 0.192
AF+/mortality 20 (58.8)   56 (58.9) – 0.511
AF–/mortality 34 (77.2)   76 (80.8) – 0.803
p‡ 0.080 < 0.001

Candida species distribution and frequency of antifungal use in the study groups.

Total FLC CAS ANI MIC AMB
Group 1
n 78 12 11 3 3 5
C. albicans 43 (55.1) 6 (50.0) 5 (45.5) 0 (0.0) 1 (33.3) 3 (60.0)
C. dubliniensi 1 (1.3) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0)
C. glabrata 7 (9.0) 1 (8.3) 1 (9.1) 1 (33.3) 0 (0.0) 0 (0.0)
C. krusei 3 (3.8) 1 (8.3) 0 (0.0) 0 (0.0) 2 (66.7) 1 (20.0)
C. lusitaniae 1 (1.3) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0)
C. parapsilosis 14 (17.9) 3 (25.0) 3 (27.3) 1 (33.3) 0 (0.0) 0 (0.0)
C. tropicalis 9 (11.5) 1 (8.3) 2 (18.2) 1 (33.3) 0 (0.0) 1 (20.0)
Group 2
n 189 46 32 9 4 4
C. albicans 123 (65.1) 34 (73.9) 22 (68.8) 7 (77.8) 3 (75.0) 0 (0.0)
C. glabrata 9 (4.7) 1 (2.2) 1 (3.1) 1 (11.1) 1 (25.0) 1 (25.0)
C. kefyr 2 (1.1) 2 (4.3) 0 (0.0) 0 (0.0) 0 (0.0) 1 (25.0)
C. krusei 2 (1.1) 0 (0.0) 1 (3.1) 0 (0.0) 0 (0.0) 0 (0.0)
C. lusitaniae 1 (0.5) 0 (0.0) 1 (3.1) 0 (0.0) 0 (0.0) 0 (0.0)
C. parapsilosis 29 (15.3) 4 (8.7) 3 (9.4) 0 (0.0) 0 (0.0) 1 (25.0)
C. tropicalis 22 (11.6) 5 (10.9) 4 (12.5) 1 (11.1) 0 (0.0) 1 (25.0)
Group 4 (53.8% of candidemia)
n 42 9 6 1 0 3
C. albicans 26 (61.9) 5 (55.6) 4 (66.7) 0 (0.0) 0 (0.0) 3 (100.0)
C. parapsilosis 10 (23.8) 3 (33.3) 2 (33.3) 0 (0.0) 0 (0.0) 0 (0.0)
C. glabrata 1 (2.4) 0 (0.0) 0 (0.0) 1 (100.0) 0 (0.0) 0 (0.0)
C. tropicalis 3 (7.1) 1 (11.1) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0)
C. krusei 1 (2.4) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0)
C. duplensie 1 (2.4) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0)
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