Article

P-1929. Impact of the COVID-19 Pandemic on the Risk Factors and Outcomes Associated with Candidemia

Authors:
Melat Endashaw
Melat Endashaw
Melat Endashaw
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Austin Dykes
Austin Dykes
Austin Dykes
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Rachael Clark
Rachael Clark
Rachael Clark
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Laila Warrayat
Laila Warrayat
Laila Warrayat
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Abstract

Background Cases of candidemia surged during the COVID-19 pandemic, possibly due to the intensive treatments used in critically ill patients. This study aims to explore the impact of the pandemic on risk factors and clinical outcomes associated with candidemia. Methods We retrospectively analyzed patients ≥ 18 years diagnosed with candidemia at a single facility in Albany, Georgia, between January 2017 and May 2023. Patients were categorized into three groups based on their COVID-19 status and admission date (January 21, 2020, marking the first US case): 1) pre-pandemic (before January 21, 2020), 2) pandemic with COVID-19 (after January 21, 2020), and 3) pandemic without COVID-19 (after January 21, 2020). We compared risk factors for candidemia and in-hospital mortality across these groups. Results A total of 89 patients were included, with 44% pre-pandemic and 56% during the pandemic (half with COVID-19) (Table 1). Baseline characteristics were similar, except for a higher median number of comorbidities in the pre-pandemic group (p=0.008). Notably, the COVID-19 group had a significantly higher proportion of patients with no comorbidities (12%) compared to the pre-pandemic (0%) and pandemic without COVID-19 (4%) groups (p=0.01). Patients with COVID-19 were predominantly diagnosed with candidemia in the ICU (92%) compared to pre-pandemic (49%) and pandemic without COVID-19 (44%) groups (p< 0.001). Additionally, mechanical ventilation and vascular catheters were more frequent in the COVID-19 group (88% and 96%, respectively) compared to the pre-pandemic (31% and 62%) and pandemic without COVID-19 (40% and 68%) groups (p< 0.001 for both) (Table 2). While immunosuppressive medications were uncommon, glucocorticoid use was significantly higher in the COVID-19 group (76%) compared to the pre-pandemic (18%) and pandemic without COVID-19 (24%) groups (p=0.008). In-hospital mortality was highest among patients with COVID-19 (76%) compared to patients before the pandemic (44%) and those without COVID-19 during the pandemic (32%) (p< 0.005). Conclusion Patients with COVID-19 displayed a higher prevalence of candidemia risk factors and significantly worse clinical outcomes, including higher in-hospital mortality, compared to the other groups. Disclosures All Authors: No reported disclosures

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