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Outbreak of Candida parapsilosis fungemia in an intensive care unit during a COVID surge: an epidemic within a pandemic

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Abstract

We sought to investigate epidemiology, risk factors, clinical features, and outcome of the C. parapsilosis blood stream infection (BSI) outbreaks observed during the first surges of COVID-19 pandemic in our population. Retrospective, monocentric observational study in the 24 bed intensive care unit (ICU) of a tertiary care medical center in northern Italy, from 2019 to 2021 first 5 months. 2030 patients were enrolled, of whom 239 were COVID-19 positive. The total incidence of Candida-BSI was 41.9 per 1000 admissions, with two outbreaks during 2020 spring and winter’s COVID surges. The total numbers of C. parapsilosis BSI cases are 94, of which 21 during the first outbreak and 20 during the second. In our population, COVID-19 was strongly associated with C. parapsilosis BSI (OR 4.71, p < 0.001), as well as continuous renal replacement therapy (CRRT) (OR 3.44, p = 0.001), prolonged antibiotic therapy (OR 3.19, p = 0.004), and delayed infusion sets replacements (OR 2.76, p = 0.015). No statistically significant association was found between Candida-BSI episodes and mortality, when adjusted for other known outcome risk factors. COVID surges undermined the infectious control measures in our ICU, leading to two outbreak of C. parapsilosis BSI. A stricter, thorough management of intravascular devices and infusion set is crucial in prevention of catheter related BSI, and awareness must be kept high, especially in emergencies circumstances, such as the ongoing COVID-19 pandemic.

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Data availability

The anonymized dataset is available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Anesthesia and Intensive Care Department, IRCCS Policlinico San Matteo, Pavia, Italy

    Alessandro Amatu, Guido Tavazzi, Federico Capra Marzani & Francesco Mojoli

  2. Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy

    Ruben M. Trani, Marta Voltini, Guido Tavazzi, Fausto Baldanti & Francesco Mojoli

  3. Microbiology and Virology Department, IRCCS Policlinico San Matteo, Pavia, Italy

    Caterina Cavanna, Patrizia Cambieri, Marta Corbella & Fausto Baldanti

  4. IRCCS Policlinico San Matteo, Pavia, Italy

    Alba Muzzi

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Contributions

Conceptualization: A. A. and R. M. T.; formal analysis: A. A., F. M., and R. M. T.; investigation: M. V., P. C., C. C., and M. C.; project administration: A. A.; supervision: F. B. and F. M.; validation: A. A. and F. M.; writing—original draft: A. A. and R. M. T.; writing—review and editing: A. A., R. M. T., M. V., G. T., F. C. M., C. C., P. C., M. C., A. M., F. B., and F. M.. All authors agreed to be accountable for all aspects of the work, ensuring that questions related to the accuracy or integrity of any part of the work have been appropriately investigated and resolved. All authors revised the work critically for important intellectual content. All authors have read and agreed to the published version of the manuscript.

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Correspondence to Alessandro Amatu.

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Ethical approval was provided by the Local Ethics Committee (Comitato Etico Pavia, Pavia, Italy, protocol number 0014228/23, approval date 15/03/2023).

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Informed consent for data collection was obtained according to national regulations and to European General Data Protection Regulation.

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Competing interests

FM declares fee for lectures from Hamilton Medical, GE Healthcare, SEDA Spa. The other authors declare no competing interests.

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Amatu, A., Trani, R.M., Voltini, M. et al. Outbreak of Candida parapsilosis fungemia in an intensive care unit during a COVID surge: an epidemic within a pandemic. Eur J Clin Microbiol Infect Dis 42, 1347–1353 (2023). https://doi.org/10.1007/s10096-023-04670-1

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