Candidemia in the ICU: Impact of the COVID-19 Pandemic and Earthquake Crisis on Mortality and Treatment Outcomes

Abstract Background: Candidemia is a serious bloodstream infection with high mortality, particularly in intensive care unit (ICU) patients. Its epidemiology is influenced by evolving practices, resistance, and extraordinary circumstances such as pandemics and disasters. This study aimed to analyze candidemia epidemiology, risk factors, and outcomes, focusing on the impact of the COVID-19 pandemic and a major earthquake in southern Türkiye. Methods: We conducted a five-year retrospective cohort study (2018–2023) including 734 adult ICU patients with candidemia. Clinical, demographic, and laboratory data were extracted, and cases were grouped as candidemia-only, candidemia with COVID-19, and candidemia with earthquake-related injury. Multivariable logistic regression identified predictors of 30-day mortality, and model performance was assessed using ROC analysis. Results: The analysis included 734 candidemia cases. We observed a significant difference in 30-day mortality between the candidemia-only group and the combined SARS-CoV-2 and earthquake groups (p=.024). Multivariate logistic regression identified several independent risk factors for 30-day mortality, including high Charlson Comorbidity Index (CCI) scores (OR: 1.34; p=.001), high Candida scores (OR: 2.26; p<.001), intubation (OR: 1.53; p=.027), the presence of shock (OR: 1.66; p=.011), and total parenteral nutrition (TPN) use (OR: 3.49; p<.001). The predictive model demonstrated good performance with an Area Under the Curve (AUC) value of 0.81. Conclusion: Comorbidities, clinical severity, and invasive interventions are major determinants of candidemia mortality. Extraordinary events such as pandemics and earthquakes further worsen outcomes. Early antifungal initiation is crucial to improve survival. These findings highlight the importance of surveillance and timely interventions in critically ill patients, particularly during public health emergencies.