COVID-19 pandemic and the evolving epidemiology of Candidemia: A topic of concern!!!

Candidemia is the most common recorded invasive fungal infection worldwide. During the last couple of years, the world has been struggling with the COVID-19 pandemic caused by the Severe Acute Respiratory Syndrome Corona Virus (SARS-CoV-2), during which an increase in the incidence of candidemia and Candida auris cases were reported by several researchers. This study aimed to address how the entire landscape evolved during the downslide of the COVID-19 pandemic over the study period that spanned five years, including the pre-pandemic, peak, and waning of the COVID-19 pandemic. This retrospective observational study was conducted on a cohort of 1450 tertiary care cases in a University hospital in Jaipur, India, from July, 2017 to November, 2021. During the study period, all blood cultures of the suspected sepsis cases were screened for candidemia. Identification and antifungal susceptibility testing of Candida isolates were carried out using the standard assays. A consistent increase in the prevalence of candidemia has been observed during the current study period. Despite this, the prevalence of Non albicans Candida has remained almost steady. A sharp increase in C. auris candidemia during the COVID-19 pandemic was observed. The waning of the COVID-19 pandemic has brought the epidemiology of candidemia back to the pre-pandemic times, and C. tropicalis has become the predominant clinical isolate again. There is a slight fall in resistance to fluconazole. Echinocandins, which is considered as a remedy till few years back, has also showed first signs of emerging resistance in patients attending to Mahatma Gandhi University of Medical Sciences & Technology (MGUMST), Jaipur, Rajasthan, India. Due to the extreme overlapping of the associated disease/ risk factors observed between COVID-19 and candidemia, these two disease entities have definitely influenced the epidemiology of each other's. However, how the landscape will evolve in the aftermath of the COVID-19 pandemic is yet to be detected.