Candidemia in Post-COVID Era: Increasing incidence of endemic fluconazole-resistant Candida parapsilosis and Candidozyma auris.

Authors

Anastasia Spiliopoulou, Lamprini Βania, Ioanna Giannopoulou, Lydia Leonidou, Maria Lagadinou, Vasileios Karamouzos, Fotini Fligou, Alexandra Lekkou, Stelios Assimakopoulos, Markos Marangos, Michalis Leotsinidis, Myrto Christofidou, Fevronia Kolonitsiou, Fotini Paliogianni

Published in

International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases. Pages 109018. Jul 30, 2026. Epub Jul 30, 2026.

Abstract

To assess the effect of the COVID-19 pandemic on the epidemiology of candidemia.
We retrospectively analyzed candidemia episodes diagnosed from 2018 to 2024 in a tertiary university hospital, evaluating incidence trends, species distribution, ward origin, antifungal susceptibility, and antifungal consumption in the context of the COVID-19 pandemic.
Candidemia incidence remained high beyond the COVID-19 pandemic, particularly in intensive care unit. Candida parapsilosis species complex was the predominant pathogen, accounting for 41.4% in the post-COVID era, and exhibited persistently high fluconazole resistance rates of up to 64.3% together with increasing resistance to voriconazole. Increased azole resistance was associated with isolation from intensive care units. Candidozyma auris (Candida auris), first identified in 2022, rapidly became endemic, accounting for 29.5% of isolates in the post-COVID era and exhibiting uniform resistance to fluconazole. Candida albicans (18.5%) ranked as the third most frequently isolated species. Amphotericin B and echinocandins retained excellent in vitro activity, whereas the clinical utility of fluconazole was markedly reduced due to the high prevalence of resistant C. parapsilosis and C. auris.
The COVID-19 pandemic was associated with a sustained increase in candidemia incidence, major shifts in species distribution, and high fluconazole resistance rates. These findings underline the need for ongoing surveillance and implementation of infection control measures.

PMID:
42532402
Bibliographic data and abstract were imported from PubMed on 31 Jul 2026.

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