Risk Factors for the Development of Fungal Infections in COVID-19.

Abstract

Background. Coronavirus disease 2019 (COVID-19) in a proportion of hospitalized patients is associated with the development of severe disease and secondary infectious complications, among which fungal infections are of particular clinical significance. However, it remains unclear to what extent their occurrence is determined by comorbid conditions and disease severity versus the effects of anti-inflammatory therapy. Objective. To assess the impact of comorbidities and pathogenetic therapy on the development of fungal infections in hospitalized patients with COVID-19. Methods. A retrospective single-center observational study was conducted, including 797 patients aged ≥18 years with laboratory-confirmed COVID-19 who were hospitalized between 2020 and 2023. Patients were stratified according to the presence of fungal infections. Clinical and demographic characteristics, comorbidities, disease severity, extent of lung involvement based on computed tomography, and features of anti-inflammatory therapy were analyzed. Univariate and multivariate logistic regression analyses were performed with calculation of odds ratios (OR) and 95% confidence intervals (CI). Results. Fungal infections were diagnosed in 181 (22.7%) patients. Their occurrence was significantly more frequent in older patients, those with severe COVID-19, and those with a pronounced comorbid background (p0.001). In univariate analysis, significant factors included cardiovascular diseases, diabetes mellitus, kidney disease, chronic respiratory diseases, and HIV infection, with the strongest association observed for HIV infection (OR 9.10; 95% CI 2.70–30.70; p0.001) and severe lung involvement (CT-4: OR 4.28; 95% CI 1.95–9.42; p0.001). In the etiological structure, fungi of the genus Candida, predominantly Candida albicans, prevailed, whereas Aspergillus spp. were detected rarely and were associated with extremely severe disease. The use of glucocorticosteroids (OR 3.11; 95% CI 2.12–4.56; p0.001) and interleukin-6 inhibitors was associated with an increased risk of fungal infections in univariate analysis; however, in multivariate analysis adjusted for age, a statistically significant association persisted only for glucocorticosteroids (OR 2.09; 95% CI 1.16–3.74; p=0.014). Conclusion. The development of fungal infections in patients with COVID-19 is associated with age, disease severity, and comorbid conditions. The use of glucocorticosteroids represents an independent risk factor, whereas the observed associations with interleukin-6 inhibitors likely reflect disease severity. The limitations of the study include its retrospective design and single-center setting.