Candida Infections in COVID-19 Patients: A Review of Prevalence, Risk Factors, and Mortality

Candida spp. infections have increasingly been reported among COVID-19 patients, yet the epidemiological factors, diagnostic methods, and outcomes associated with these infections remain poorly understood. These infections, particularly in ICU settings, present significant challenges due to high mortality rates and rising antifungal resistance. This study aimed to investigate the occurrence, risk factors, treatment, and outcomes of Candida albicans and non-albicans Candida in COVID-19 patients, providing clinical and epidemiological insights. A review following PRISMA guidelines was conducted. Searches were performed in PubMed, Embase, and BVS databases, covering articles published from January 2020 to May 2024. Inclusion criteria included case reports or case series providing detailed information on Candida spp. in COVID-19 patients. Data extraction focused on patient demographics, underlying diseases, antifungal and antibiotic therapies, antifungal susceptibility, resistance profiles, and outcomes. Statistical analyses were conducted using SPSS software. The review included 67 studies, totaling 223 COVID-19 patients. Male patients were predominant. Common comorbidities included hypertension, cancer, and dyslipidemia. Echinocandins were the primary antifungal treatment. Non-albicans Candida exhibited a higher resistance rate (47.10 %) compared to C. albicans (2.35 %). Overall mortality rates were high, at 60.50 % for C. albicans and 62.30 % for non-albicans. Significant risk factors for mortality included age, central venous catheter use, ICU admission, and corticosteroid therapy. The study identified critical risk factors and clinical characteristics in COVID-19 patients with Candida infections. The high incidence of antifungal resistance among non-albicans and high mortality rates highlight the need for vigilant monitoring and targeted antifungal strategies to improve outcomes.