Candidemia is the leading invasive fungal infection in hospitals and is associated with high mortality. Changes in the profile of species and affected patient populations have occurred in recent years, intensified by the COVID-19 pandemic, which significantly increased its incidence. However, there are limited data on the post-pandemic scenario. To analyze candidemia regarding the temporal distribution of species and its impact on clinical outcomes in children, hematologic patients, and intensive care patients, emphasizing changes observed in the post-pandemic period. Observational study conducted at a referral hospital between 2018 and 2025, which includes a bone marrow transplant unit and a neonatal intensive care unit. Patients were stratified by period: pre-pandemic (2018–2019), pandemic (2020–2021), and post-pandemic (2022–2025). Incidence rates were calculated per patient-day (pt-day). For outcome analyses, only patients who received antifungal treatment were considered. During the study, 177 episodes of candidemia occurred in patients with a median age of 66 years, including 19 (11%) pediatric patients. C. krusei and C. glabrata accounted for 18% of cases. The increase in incidence during the pandemic period (0.34/1,000 pt-days) returned to pre-pandemic levels (0.21 and 0.24/1,000 pt-days in the pre- and post-pandemic periods, respectively). Among species, the main change occurred in C. krusei/glabrata , with incidence rising from 0.04 to 0.08/1,000 pt-days during the pandemic period and returning to 0.04 post-pandemic. Antifungal therapy was administered in 129 (73%) cases and these were analyzed for outcomes; the remaining 48 (27%) died before therapy initiation. C. albicans (67% vs. 40%; p = 0.016) was associated with higher mortality, whereas C. parapsilosis (32% vs. 55%; p = 0.02) was associated with lower mortality. Children (18% vs. 53%; p = 0.01), hematologic patients (36% vs. 57%; p = 0.07), and cases occurring outside the intensive care unit (19% vs. 61%; p = 0.002) had the lowest mortality rates. In the post-pandemic period, candidemia incidence decreased, but mortality rates remain high, especially among critically ill and non-hematologic patients. Children had a better prognosis. The higher lethality associated with C. albicans underscores its pathogenic potential, despite the increase in non- albicans species. Early identification and immediate initiation of treatment are essential to improve outcomes, particularly in vulnerable populations.
Garnica et al. (Sun,) studied this question.