Critical Care volume 28,
Article number: 320, Published: 27 September 2024
Background
While SARS-CoV2 infection has been shown to be a significant
risk-factor for several secondary bacterial, viral and Aspergillus infections,
its impact on intensive care unit (ICU)-acquired candidemia (ICAC) remains
poorly explored.
Method
Using the REA-REZO network (French surveillance network of
ICU-acquired infections), we included all adult patients hospitalized for a
medical reason of admission in participating ICUs for at least 48 h from
January 2020 to January 2023. To account for confounders, a non-parsimonious
propensity score matching was performed. Rates of ICAC according to SARS-CoV2
status were compared in matched patients. Factors associated with ICAC in
COVID-19 patients were also assessed using a Fine-Gray model.
Results
A total of 55,268 patients hospitalized at least 48 h
for a medical reason in 101 ICUs were included along the study period. Of
those, 13,472 were tested positive for a SARS-CoV2 infection while 284 patients
developed an ICAC. ICAC rate was higher in COVID-19 patients in both the
overall population and the matched patients’ cohort (0.8% (107/13,472) versus
0.4% (173/41,796); p < 0.001 and 0.8% (93/12,241)
versus 0.5% (57/12,241); p = 0.004,
respectively). ICAC incidence rate was also higher in those patients (incidence
rate 0.51 per 1000 patients-days in COVID-19 patients versus 0.32 per 1000
patients-days; incidence rate ratio: 1.58 [95% CI:1.08–2.35]; p = 0.018). Finally, patients with
ICAC had a higher ICU mortality rate (49.6% versus 20.2%; p < 0.001).
Conclusion
In this large multicenter cohort of ICU patients, although
remaining low, the rate of ICAC was higher among COVID-19 patients.
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