The COVID-19 pandemic led to an increase in hospitalizations of critically ill patients, driving greater use of antibiotics, corticosteroids, and invasive devices, resulting in higher rates of nosocomial infections. This study analyzed the incidence of healthcare-associated fungal infections in adult and pediatric patients admitted to intensive care units at a tertiary hospital in northeastern Brazil, between January 2018 and December 2024. This was a cross-sectional study in which medical records and notifications from the Hospital Infection Control Committee were analyzed. The pre-pandemic (2018–2019), pandemic (2020–2022), and post-pandemic (2023–2024) periods were compared. Samples were processed using automated systems (MALDI-TOF and Vitek 2). Fisher’s exact test was used to assess statistical significance. A total of 613 infections were recorded during the study period, of which 179 (29%) were fungal infections. Primary bloodstream infection was the most frequent, totaling 111 cases (62.0%), increasing from 10.8% in the pre-pandemic period to 27.9% during the pandemic, before decreasing to 15.6% in the post-pandemic period (p = 0.045). Ventilator-associated pneumonia accounted for 60 cases (33.5%), with 6.7% in the pre-pandemic period, 16.2% during the pandemic, and 10.6% in the post-pandemic period (p = 0.032). Other infections, such as urinary tract infections and peritonitis, accounted for 23 cases (12.8%). The most affected sector was the adult COVID-19 patient unit, where 100 cases (55.9%) occurred (p < 0.0005), followed by adult non-COVID units with 67 cases (37.4%), and the pediatric unit, which cared for patients with and without COVID-19, where 12 infections (6.7%) were identified during the period. Analysis of etiological agents revealed a predominance of Candida albicans , responsible for 54 cases (30.2%), followed by C. parapsilosis (33 cases, 18.4%) and C. tropicalis (31 cases, 17.3%). Other agents, such as C. famata (14 cases, 7.8%) and C. glabrata (9 cases, 5.0%), were less frequent. Species such as C. ciferri , C. cruzei , and Cryptococcus neoformans were identified in six cases (3.3%) each, while C. pelliculosa , Candida spp. , C. rugosa , and C. krusei appeared in four cases (2.2%) each. During the pandemic, fungal infections showed an increased incidence, especially primary bloodstream infections and ventilator-associated pneumonias. Candida albicans was the most prevalent agent, followed by C. parapsilosis and C. tropicalis .
Santos et al. (Sun,) studied this question.
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