Increase in the incidence of Candida parapsilosis and Candida tropicalis bloodstream infections during the coronavirus disease 2019 (COVID-19) pandemic

The mortality among patients with candidemia remains high and is associated with increasing in incidence of non–Candida albicans Candida spp.1,2 Previous studies have suggested that non–C. albicans candidemia has increased during the coronavirus disease 2019 (COVID-19) pandemic, probably due to the increasing use of central venous catheters, suboptimal catheter care, and concurrent corticosteroid use.3–5 Candida parapsilosis bloodstream infection (BSI) has been associated with the overuse of central venous catheters and receipt of parenteral nutrition, and risk factors for Candida tropicalis are poorly defined.6,7 Overall, the C. parapsilosis and C. tropicalis BSI incidence rates at Thammasat University Hospital increased from 0.42% to 2.24% and from 1.68% to 7.46% between 2019 and 2021, respectively, whereas the rate of C. albicans BSI remained stable at 6.70%–7.83%. Characteristics and Outcomes of the Patients With C. parapsilosis and C. tropicalis BSI Compared With Patients With C. albicans Bloodstream Infection Variables C. parapsilosis (n = 9) C. albicans (n = 40) P Value C. tropicalis (n = 20) C. albicans (n = 40) P Value Age, median y (IQR) 45 (1–90) 68 (2–95) .06 64 (23–91) 68 (2–95) .39 Sex, male, no. (%) 4 (44.4) 20 (50) .77 13 (65) 20 (50) .28 Comorbidities, no. (%) DM 3 (33.3) 12 (30) .85 5 (25) 12 (30) .69 Gastrointestinal disease 2 (22.2) 2 (5) .09 6 (30) 2 (5) .01 Malignancy 2 (22.2) 14 (35) .47 5 (25) 14 (35) .44 Immunocompromised 1 (11.1) 9 (22.5) .45 5 (25) 9 (22.5) .83 Othersa 0 (0) 18 (45) .08 10 (50) 18 (45) .84 Source of candidemia, no. (%) CLABSI 7 (77.8) 27 (67.5) .55 14 (70) 27 (67.5) .85 Intraabdominal 1 (11.1) 5 (12.5) .91 5 (25) 5 (12.5) .23 Urinary tract 0 (0) 8 (20) .15 1 (5) 8 (20) .13 Unknown 1 (11.1) 5 (12.5) .91 1 (5) 5 (12.5) .10 APACHE II score, median (IQR) 11.0 (2–20) 16.5 (2–26) .18 14 (4–32) 16.5 (2–26) .30 Risk factor, no. (%) Indwelling CVCs/PICCs 7 (77.8) 28 (70) .64 14 (70) 28 (70) 1.00 Parenteral nutrition 5 (55.6) 11 (27.5) .11 5 (25) 11 (27.5) .84 Urinary catheter 4 (44.4) 36 (90) .002 18 (90) 36 (90) 1.00 Mechanical ventilator 3 (33.3) 31 (77.5) .01 14 (70) 31 (77.5) .53 Duration of central venous catheter insertion, median d (IQR) 19.5 (12–27) 18.6 (10.6–26.6) .08 22.5 (9.5–35.5) 18.6 (10.6–26.6) .02 Total antifungal duration, median d (IQR) 17 (3–53) 9.5 (0–79) .05 5 (0–25) 9.5 (0–79) .64 Adequate antifungal therapy, no. (%) 8 (88.9) 28 (70) .25 16 (80) 28 (70) .41 Source control, no. (%) 8 (88.9) 24 (60) .