Candidemia in the intensive care unit before and during the COVID-19 pandemic: a cross-sectional analysis.

Objectives: Increased incidences of candidemia have been reported among intensive care unit (ICU) patients during the COVID-19 pandemic. Methods: The study included adult patients diagnosed with candidemia in the ICU during two periods from January 1, 2017, to December 31, 2022, that were separated by the in-country declaration of COVID-19. We evaluated the incidences of candidemia during two periods marked by transformation of an old tertiary hospital into a completely new and modern facility, which took place just before the emergence of the pandemic. Results: During the pre-COVID-19 and COVID-19 periods, 3796 and 10,467 patients were admitted to the ICU, of whom 61 (1.6%, incidence 2.03 per 1000 ICU-days) and 62 (0.6%, incidence 0.66 per 1000 ICU-days) patients developed candidemia, respectively. The median time to candidemia detection was significantly longer in the COVID-19 period (34 vs 29 days, P = 0.022). During the pre-COVID-19 period, Candida parapsilosis (68.9% vs 37.1%) was the most predominant species, which was superseded during the COVID-19 period by C. albicans (35.5% vs 16.4%). Fluconazole resistance was significantly lower in the COVID-19 period (14.5% vs 31.1%, P = 0.027), with a lower resistance rate of C. parapsilosis (21.7% vs 38.1%). Of 3,094 (29.6%) patients with COVID-19, candidemia developed in nine patients ( 0.29%) as compared with 53 patients (0.72%) without COVID-19. Conclusions: Despite reports on increased incidences of candidemia among ICU patients during the COVID-19 period, lower incidences of candidemia found in the present study both during the COVID-19 period and among COVID-19 patients may be attributed to the complete transformation of our facility.