Severe Candida infections in critically ill patients with COVID-19

•A Candida co-infection can be either primary- or secondarily acquired, i.e., presented together with or following the onset of COVID-19 disease (super-infection).•Immunosuppressants, such as corticosteroids and anti-IL-6 agents, predispose to fungal overgrowth and translocation from the gastrointestinal tract to the bloodstream.•Critically ill COVID-19 patients often presented altered fecal mycobiomes, enriched with members of the genus Candida.•Candida spp. from blood followed Gram-negative and Gram-positive bacteria as the most common nosocomial isolates in patients already infected with COVID-19.•It has been reported that hospital-onset candidemia rate significantly increased during the COVID-19 pandemic, however incidence varied significantly between studies.•C. albicans led the isolates in COVID-19 and invasive Candida co-infection in several reports, while the reported incidence of C. parapsilosis and C.auris increased during the pandemic.•The knowledge of Candida spp. local epidemiology, concerning resistance to antifungal agents, remains crucial for the selection of the empirical antifungal treatment.•During the COVID-19 pandemic, an increase in the frequency of resistance to fluconazole have been reported.•The first-line treatment consists of intravenous administration of fluconazole (unless there is local-resistance to fluconazole or suspicion for C. auris) or an echinocandin.•C. auris is a troublesome pathogen as it can persist in the hospital environment and has modes of transmission like multidrug resistant bacteria. The treatment of C. auris is challenging, as it may present resistance to several (or even all) major antifungal classes, i.e., polyenes, azoles, and echinocandins.•Invasive Candida on critically ill patients with COVID-19, increasing morbidity and mortality. Proper awareness and prevention efforts might decrease their incidence and improve their prognosis. The frequency of co-infections with bacterial or fungal pathogens has constantly increased among critically ill patients with coronavirus disease 2019 (COVID-19) during the pandemic. Candidemia was the most frequently reported invasive fungal co-infection. The onset of candidemia in COVID-19 patients was often delayed compared to non-COVID-19 patients. Additionally, Candida invasive infections in COVID-19 patients were more often linked to invasive procedures (e.g., invasive mechanical ventilation or renal replacement therapy) during the intensive care stay and the severity of