Candidemia Epidemiology and Antifungal Resistance in Critically-ill Patients During and After COVID-19 Pandemic: Comparison Between Two Hospitals in Greece and Türkiye

BACKGROUND: Candidemia is a life-threatening invasive fungal infection, particularly in patients admitted to intensive care units (ICUs). Epidemiology of candidemia and antifungal resistance have been significantly affected in COVID-19 pandemic. METHODS: We analysed candidemia cases in neonatal, paediatric, and adult ICUs at Hippokration General Hospital in Thessaloniki, Greece (site 1) and Kayseri City Training and Research Hospital in Kayseri, Türkiye (site 2) from January 2020 to December 2023. Epidemiology, species distribution, and antifungal susceptibility of cases were compared. RESULTS: A total of 388 patients from site 1 and 379 patients from site 2 were included. A significant increase in the incidence of candidemia was observed in both hospitals during the COVID-19 pandemic. Candida parapsilosis was the most common species in all ICUs at Site 1, while Candida albicans was predominant at Site 2. C. parapsilosis became the most frequent species at Site 2 after 2021. C. glabrata was isolated more frequently in Site 1, whereas C. tropicalis was more frequently isolated in Site 2. A total of 14 C. auris strains were isolated, 13 of which were at the site 1. Over 90% of C. albicans strains were fluconazole-sensitive, but resistance was high in C. parapsilosis strains (47% at the site 1 and 40% at the site 2). CONCLUSION: C. parapsilosis and C. albicans remained the most common species, but their distributions varied between the two locations and over time. The high fluconazole resistance in C. parapsilosis causes a significant challenge for treatment. These findings highlight the necessity of continuous epidemiological surveillance to ensure appropriate antifungal treatment in different geographical regions.