US saw heavy toll from fungal infections during COVID-19 pandemic
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Key takeaways:
- Hospitalizations involving fungal infections increased 8.5% each year during 2019 to 2021.
- Patients hospitalized with COVID-19-associated fungal infections had higher in-hospital mortality rates.
Hospitalizations that involved fungal infections increased by more than 8% in the United States during the COVID-19 pandemic compared with previous years, researchers found.
They also found that mortality rates for patients hospitalized with COVID-19-related fungal infections were around four times higher than mortality rates for patients with fungal infections that were not associated with COVID-19, according to findings published in Emerging Infectious Diseases.
“We performed this study because we wanted to provide more comprehensive data about the impact of fungal infections in the United States,” Jeremy A.W. Gold, MD, MS, a medical officer in the CDC’s Mycotic Diseases Branch, told Healio.
“We know that COVID-19 can predispose patients to developing fungal infections and that fungal infections in patients with COVID-19 are associated with poor outcomes, but comprehensive data on this problem were lacking,” Gold said.
Using data from a hospital-based database used by the CDC to inform COVID-19 response activities, Gold and colleagues estimated the annual hospitalization rates per 10,000 population by fungal infection type and calculated the average annual percentage change during 2019 to 2021.
According to the study, for COVID-19-associated fungal hospitalizations, the team calculated hospitalization rates per 10,000 COVID-19 hospitalizations and stratified 2020 to 2021 fungal hospitalizations by COVID-19 association and fungal infection type. They then compared patient demographics, U.S. hospital census regions and urban-rural classifications, lengths of hospital stays, ICU admissions, invasive mechanical ventilation (IMV) receipt and in-hospital deaths.
The identified 59,212 fungal hospitalizations during 2019 to 2021, with rates of fungal hospitalizations per 10,000 hospitalizations increasing from 22.3 in 2019 to 25 in 2020 and 26.8 in 2021 (P < .01), representing an average annual percentage change of 8.5%.
According to the study, 13.4% of fungal hospitalizations during 2020 to 2021 were related to COVID-19. The rates of COVID-19-associated fungal hospitalizations per 10,000 COVID-19 hospitalizations increased from 43.1% to 57.4% (24.9%; P < .01) across the study period, with infections involving blastomycosis (65.6% change), aspergillosis (58.2% change) and mucormycosis (39.8% change) increasing the most.
Compared with hospitalizations of patients with non-COVID-19-associated fungal infections, hospitalizations of patients with COVID-19-associated fungal infections generally involved longer hospital stays (21 days vs. 9 days; P < .01), ICU-level care (70% vs. 35.5%; P < .01), receipt of IMV (64.4% vs. 22.5%; P <.01) and increased in-hospital deaths (48.5% vs. 12.3%; P <.01).
COVID-19-associated fungal hospitalizations with the highest percentages of deaths involved aspergillosis (57.6%), invasive candidiasis (55.4%), mucormycosis (44.7%) and unspecified mycoses (59%).
Gold and colleagues also found that hospitalizations with COVID-19–associated fungal infections occurred more frequently among Hispanic/Latino men compared with hospitalizations with fungal infections that were not related to COVID-19.
“We hope that our study will promote increased awareness about fungal diseases among clinicians, particularly in people with COVID-19, as earlier testing and treatment for fungal infections can save lives,” Gold said. “We also think it is critical to highlight the racial and ethnic disparities observed among people having severe diseases caused by fungal infections. Other factors linked to inequities, particularly differences in underlying conditions that increase fungal disease risk (eg, diabetes) and health status before COVID-19 infection, likely contributed to the observed racial/ethnic disparities in fungal burden.”
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