The impact of fungal infections on the course of disease in patients with COVID-19: a prospective observational study

Abstract

Objective: to analyze the manifestations of fungal complications in COVID-19 and their impact on the course and outcome of the disease, taking into account comorbid pathology. Materials and methods: the types of fungal complications were studied in 118 adult hospitalized patients with COVID-19. The comparison groups consisted of 23 patients who died with fungal complications, 35 patients who died without fungal complications, 35 patients who recovered with fungal complications, and 25 patients who recovered without fungal complications. Results: it was established that the presence of fungal flora worsens the course of COVID-19 and is associated with an unfavorable prognosis. The timing of diagnosis and the location of the pathogen isolation are key: the detection of a fungal infection in the third week and later is significantly associated with a fatal outcome. Candidemia (the isolation of fungi from sputum) is an unfavorable prognostic sign, requiring instrumental monitoring and the prescription of antifungal therapy. Risk factors for developing fungal complications include age over 60, chronic cardiovascular and respiratory diseases, hypothyroidism, cancer, and HIV infection. Fungal pathogens are predominantly Candida albicans (96.6%). A combination of fungal and bacterial infections, particularly P. aeruginosa, MDR Acinetobacter, K. pneumoniae, and A. baumannii , is a prognostic marker for an adverse outcome. Conclusion: the data obtained support the need for early mycological monitoring in patients with COVID-19, especially those with risk factors, to promptly identify fungal complications and initiate appropriate therapy, which can significantly improve the prognosis.