Candidemia in a Hospital Center in Northeast Brazil: An Evaluation Before, During, and After the Covid-19 Pandemic

Candidemia is a systemic infection caused by yeasts of the genus Candida . It is widely recognized as a major cause of morbidity and mortality in healthcare settings. The aim of this study was to evaluate the occurrence of candidemia from 2018–2024 in a public hospital in Ceará, Brazil. A retrospective cohort study was conducted in patients diagnosed with candidemia. Demographic, clinical, laboratory, and microbiological data were collected from medical records. Three periods were considered: pre-pandemic (2018–2019), pandemic (2020–2022), and post-pandemic (2023–2024). Statistical analysis was performed using STATA 18.0. Sixty cases of candidemia were identified. Most occurred in the pandemic period (n = 39). Males were more affected in all periods (p = 0.761). The proportion of patients aged > 60 years was similar between periods (p = 1.000). In the pre-pandemic period (n = 6), 50% were people living with HIV/AIDS (PLWHA), while 36% and 33% were PLWHA in subsequent periods (p = 0.840). COVID-19-associated candidemia occurred predominantly during the pandemic compared to the post-pandemic period (41% vs. 13.3%; p = 0.030). The use of invasive devices and broad-spectrum antimicrobials was similar across periods (p > 0.05). Detection of candidemia after >10 days of hospitalization was less frequent in the pandemic and post-pandemic periods compared to the pre-pandemic period, but without statistical significance (p = 0.253). Identification of Candida albicans was similar across periods (33.3% vs. 35.9% vs. 26.7%; p = 0.913). Isolation of C. tropicalis and C. krusei occurred beginning in the pandemic period. One case of C. pelliculosa associated with COVID-19 was identified post-pandemic. Most pre-pandemic patients had hospital stays > 30 days (p = 0.030). Mortality was high in all three periods (83.3% vs. 69.2% vs. 80%; p = 0.668). The COVID-19 pandemic directly impacted the increased number of candidemia cases and the emergence of non-albicans Candida species in this institution. Continuous surveillance of critically ill patients is necessary for early identification and better clinical management.