Chonnam Med J.  2025 Jan;61(1):52-58. 10.4068/cmj.2025.61.1.52.

Changes in Candidemia during the COVID-19 Pandemic: Species Distribution, Antifungal Susceptibility, Initial Antifungal Usage, and Mortality Trends in Two Korean Tertiary Care Hospitals

• Lee A
• Kim M
• Kim S
• Jeong HS
• Shin SU
• Cho D
• Han D
• Kim UJ
• Yang JH
• Kim SE
• Park KH
• Jung SI
• Kang SJ

• KMID: 2564998
• DOI: http://doi.org/10.4068/cmj.2025.61.1.52

Abstract

This study aimed to investigate changes in candidemia incidence, species distribution, antifungal susceptibility, initial antifungal use, and mortality trends in Korea before and during the COVID-19 pandemic. A retrospective analysis was conducted on candidemia cases from two tertiary care hospitals in Korea between 2017 and 2022. Data were compared between the pre-pandemic (2017-2019) and pandemic (2020-2022) periods. Statistical methods included incidence rate ratios (IRRs) and multivariate Cox regression to assess 30-day mortality risk factors. A total of 470 candidemia cases were identified, with 48.7% occurring pre-pandemic and 51.3% during the pandemic. While the overall incidence of candidemia remained similar across the two periods (IRR 1.15; p=0.13), the incidence in intensive care units (ICUs) significantly increased during the pandemic (IRR 1.50; p<0.01). The distribution of Candida species did not differ significantly between the two periods. Fluconazole non-susceptibility in C. albicans markedly decreased (10.0% vs. 0.9%, p<0.01), whereas C. glabrata exhibited a significant rise in caspofungin non-susceptibility during the pandemic (0% vs. 22.4%, p<0.01). Echinocandin use increased (21.8% vs. 34.4%; p<0.01), while fluconazole use declined (48.0% vs. 32.8%; p<0.01). Although the 30-day mortality rate was higher during the pandemic (60.2% vs. 57.2%), the difference was not statistically significant (p=0.57). The findings highlight the need for region-specific surveillance and tailored management strategies to improve candidemia outcomes, especially during healthcare disruptions like the COVID-19 pandemic.

Keyword

Candidemia; COVID-19; Antifungal Susceptibility; Antifungal Agents