Abstract

Background: Managing mechanically ventilated patients in intensive care units (ICU) during the Coronavirus Disease 2019 (COVID-19) pandemic poses several multidimensional challenges. Among these, the occurrence of fungal and bacterial co-infections is detrimental to patient outcomes and creates significant diagnostic and therapeutic challenges. As insights grew, dexamethasone (DXM) administration became a standard part of the treatment strategy. Given the immunosuppressive effects of corticosteroids administered to an already vulnerable population, questions have arisen regarding the their possible impact of corticosteroids on the incidence of colonization of the respiratory tract by Candida species fungal co-infections.

Objective: The current study aimed to assess the differences in morbidity and mortality between patients with and without evidence of respiratory tract Candida species colonization This study aimed to assess whether respiratory tract colonization by Candida species influences morbidity and mortality in ventilated COVID-19 ICU patients. Furthermore, as a secondary objective, we attempted to determine whether the addition of DXM was associated with an increased incidence of Candida species colonization and whether DXM treatment contributed to differences in outcome. had any detrimental effect on the incidence of complications, considering that patients were often colonized with Candida species, possibly selected under antimicrobial pressure.

Methods: This single-center retrospective cohort study analyzed data from Polymerase Chain Reaction (PCR) confirmed COVID-19 patients receiving who required invasive ventilatory support in our ICU from March 2020 to January 2022. Patients were grouped based on the presence or absence of respiratory Candida species colonization. Clinical outcomes such as mortality, ICU length of stay (LOS) and ICU length of ventilation (LOV) were compared. In a secondary analysis, patients were grouped according to DXM exposure to explore the potential association between colonization and clinical parameters. were divided into DXM and non-DXM groups to compare the occurrence of respiratory colonization by Candida species (diagnosed through tracheal aspirates and bronchoalveolar lavage (BAL) fluid samples). In addition to DXM use, we investigated other possible confounding factors in the development of respiratory colonization by Candida species by creating two additional groups: patients displaying Candida species respiratory colonization and those without. The study was approved by the Institutional Ethics Committee of AZ Sint Blasius, Dendermonde.

Results: We included 59 patients: 38 received DXM treatment and 21 did not. Forty-three patients (73%) had positive respiratory Candida species culture results. No statistically significant difference reduction in mortality rate was observed between colonized and non-colonized ventilated COVID-19 patients. outcome in ventilated COVID-19 patients with respiratory tract Candida species colonization was revealed compared to those without. However, Candida species-colonized patients had a significantly longer ICU LOS and LOV.
Respiratory Candida colonization was more frequent in the DXM group (83%) than in the non-DXM group (74%); however, this difference was not statistically significant. An increase in colonization did not translate into worse outcomes. Once DXM became the standard treatment, we only noted a non-significant increase in patients displaying signs of respiratory tract colonization. However, this did not translate into worse outcomes.

Conclusion: In this retrospective cohort study of ventilated COVID-19 patients, respiratory Candida species colonization was not associated with increased mortality but was linked to prolonged ICU stay and mechanical ventilation. DXM treatment did not exacerbate the pathogenic behavior of Candida species or negatively impact the outcomes. in a niche field of medicine lacks sufficient power to reveal pronounced correlations. We demonstrated little difference in outcomes for patients who showed signs of Candida species respiratory tract colonization compared to those without. Notably, we did not register a single event where respiratory tract colonization led to invasive infection, indicating that this phenomenon remains benign in COVID-19. Moreover, the addition of DXM to the treatment did not intensify the pathogenic behavior of these Candida species. Further research on fungal co-infections is recommended.