During the Pandemic, COVID-19–Associated Fungal Infections Had Higher In-Hospital Mortality

As more pandemic-era data is being reported, new information is being uncovered about the effects of the acute phase of the pandemic. For example, the CDC recently reported that during 2020-2021, patients with COVID-19–associated fungal infections had higher in-hospital mortality rates (48.5%) than those with non–COVID-19–associated fungal infections (12.3%).

This data was reported in an issue of the CDC’s Emerging Infectious Diseases.

“During 2020–2021, a total of 13.4% of fungal hospitalizations were COVID-19–associated, and COVID-19–associated fungal infections were associated with ≈2-fold increase in ICU admission rates and ≈4-fold increase in in-hospital death rates compared with non–COVID-19–associated fungal hospitalizations,” the authors wrote.

“COVID-19 infection is a substantial risk factor for certain fungal infections, particularly those caused by invasive molds, likely because of COVID-19–related immune system dysregulation and immunosuppressive therapies, such as corticosteroids or other immunomodulatory medications,” they wrote.

The authors gathered the information from the Premier Healthcare Database, Special COVID-19 Release (PHD-SR), which is a US, hospital-based, all-payer database that the CDC utilizes for COVID-19 response activities.

“We estimated annual hospitalization rates (per 10,000 population) by fungal infection type and calculated average annual percentage change during 2019–2021. For COVID-19–associated fungal hospitalizations (2020–2021 only), we calculated hospitalization rates per 10,000 COVID-19 hospitalizations,” the authors wrote. “We stratified 2020–2021 fungal hospitalizations by COVID-19 association and fungal infection type and compared patient demographics, US hospital census regions and urban–rural classifications, lengths of hospital stays, intensive care unit (ICU) admissions, invasive mechanical ventilation (IMV) receipt, and in-hospital deaths.”

In the latest print issue of Contagion, Saskia V. Popescu PhD, MPH, MA, CIC, wrote about Candida auris, and this emerging and multidrug resistant fungal infection.

They calculated fungal infection hospitalizations by Cochran-Armitage tests and compared these infection hospitalizations according to the COVID-19 status using χ2 tests.

The authors reported that hospitalizations of patients with COVID-19–associated fungal infections were more frequently invasive candidiasis and aspergillosis and affected more non-White male patients in the western portion of the US.

Limitations for the study included potential underreporting of fungal infections overall, and that the data might overrepresent certain geographic areas of the country.

The authors talked about the healthcare burden in dealing with these infections during the pandemic and the need for considering the potential needs for future outbreaks or pandemics. “As the COVID-19 pandemic evolves, and to increase preparedness for future infectious diseases outbreaks, comprehensive public health surveillance for fungal diseases is needed to characterize disease epidemiology and guide efforts to prevent illness and death.”