Comparison of Candida colonization in intensive care unit patients with and without COVID-19: First prospective cohort study from Turkey

This is the first prospective cohort study comparing the time-varying colonization features of Candida species in ICU patients with and without COVID-19. In this study,1464 samples were taken from 62 COVID and 60 non-COVID ICU patients in order to determine and compare Candida colonization. All specimens were inoculated on CHROMagar Candida and CHROMagar Candida Plus media and all strains identified to the species level using MALDI-TOF MS. Patient groups were compared statistically in terms of isolated Candida species, distribution according to regions and risk factors. Patients with COVID-19 compared to non-COVID-19 patients were found more frequently colonized in oral, rectal and urine samples (p<0.05). A total of 471 strains were identified most commonly as C.albicans (42.25%) and C. glabrata (24.2%). C. auris was not isolated. Non-albicans Candida strains was found significantly more frequent in patients with COVID-19 in oral (p<0.001) and rectal regions (p<0.05). Colonization with mixed Candida species was also found to be significantly higher in the oropharyngeal region in COVID-19 patients (p<0.05). Mechanical ventilation and using corticosteroid were found higher in COVID-19 patients (p<0.05) as risk factors. Despite the high colonization rates, patients with and without COVID-19 had a low and similar rate of candidosis 9,67% and 6.67% respectively. The increase in the colonization index in COVID positives in the first week was found to be significantly higher than in COVID negative individuals (p<0.05). As a result, it was determined that despite high colonization rates, the development of candidemia was low in COVID-19 patients in the ICU of our hospital. However, non-albicans strains that may be intrinsically resistant should be considered when planning prophylactic or empirical antifungal therapy. Also, the high mixed colonization rate detected in these patients emphasizes the importance of using chromogenic media for routine evaluation.