Study of Candida Infections in Hospitalized COVID-19 Patients: An Experience at a Dedicated COVID Hospital in Central India

Authors: Aniket Goenka, Saurabh G Agarwal, Sanyogita Jain, Kuldeep Singh, Rajdeep Paul, Ajay Goenka

Keywords: Candida species, COVID-19, antifungal resistance, fluconazole, Candida albicans, Candida tropicalis, diabetes, hypertension, tertiary care hospital

Abstract: Background: Candida infections have become increasingly common in patients with COVID-19, particularly in those with comorbidities or requiring prolonged hospital stays. The growing incidence of fungal infections in COVID-19 patients is a cause for concern due to the challenges in timely diagnosis and antifungal resistance. This study aims to evaluate the prevalence, species distribution, and antifungal resistance patterns of Candida isolates from COVID-19 patients. Methodology: A total of 128 clinical samples were collected from COVID-19 patients admitted to a tertiary care hospital. The samples were subjected to direct microscopy, culture, and species identification using standard microbiological techniques. Antifungal susceptibility testing was performed using the disk diffusion method, with fluconazole, amphotericin B, and caspofungin being the primary antifungal agents tested. Results: Out of 128 samples, 84 (65.62%) were positive for Candida species. The most commonly isolated species were Candida tropicalis (40.47%), Candida albicans (32.14%), Candida glabrata (14.28%), Candida krusei (7.14%), and Candida guilliermondii (5.95%). Candida infections were more prevalent in male patients (71.62%) and those aged over 60 (87.5%). Comorbid conditions such as diabetes mellitus (65.48%) and hypertension (58.73%) were associated with higher infection rates. Antifungal resistance testing revealed resistance to fluconazole in Candida glabrata, Candida krusei, and Candida guilliermondii, whereas Candida albicans and Candida tropicalis exhibited moderate resistance. All isolates remained susceptible to amphotericin B and caspofungin. Conclusion: Candida infections are prevalent among COVID-19 patients, especially in those with comorbidities. Antifungal resistance is emerging, particularly to fluconazole, indicating the need for regular surveillance and tailored antifungal therapy. Early identification and appropriate treatment of Candida infections are crucial to improve patient outcomes in the ongoing pandemic.