Article Figures & Data
Tables
- Table 1
- Comparisons of the demographic and clinical data between coronavirus disease-19 positive and coronavirus disease-19 negative patients.
Variables COVID-19 (+) COVID-19 (-) P-values χ2 df Gender Female 34 (47.9) 20 (47.6) 0.978 0.001 1 Male 37 (52.1) 22 (52.4) Age (years), mean±SD 71±15 68±17 0.402 Number of days of hospitalization, median (IQR) 29 (20-40) 46 (28-85) 0.0002* Concomitant Gram positive infection Yes 15 (21.1) 6 (14.3) 0.366 0.82 1 No 56 (78.9) 36 (85.7) Concomitant Gram negative infection Yes 36 (50.7) 25 (59.5) 0.363 0.83 1 No 35 (49.3) 17 (40.5) Other cultures Blood 29 (59.6) 22 (71.0) 0.636 1.71 3 Urine 3 (5.9) 1 (3.2) Tracheal aspirate 16 (31.4) 7 (22.6) The others 3 (5.9) 1 (3.2) APACHE 2 score, mean±SD 18.5±8.5 21.7±11.8 0.101 Expected mortality (%), median (IQR) 25.0 (12.0-55.0) 31.4 (20.3-67.1) 0.074 Comorbidity Yes 59 (83.1) 29 (69.0) 0.082 3.02 1 No 12 (16.9) 13 (31.0) Intubation Yes 54 (76.1) 40 (95.2) 0.008* 6.94 1 No 17 (23.9) 2 (4.8) Intubation day after hospitalization, median (IQR) 3 (1-10) 2 (1-6) 0.655 CVC Yes 57 (80.3) 41 (97.6) 0.009* 6.89 1 No 14 (19.7) 1 (2.4) Parenteral nutrition Yes 53 (74.6) 41 (97.6) 0.002* 9.96 1 No 18 (25.4) 1 (2.4) Steroid Yes 62 (87.3) 12 (28.6) <0.0001* 40.30 1 No 9 (12.7) 30 (71.4) Antibiotics Yes 63 (88.7) 41 (97.6) 0.092 2.84 1 No 8 (11.3) 1 (2.4) Lymphopenia Yes 42 (59.2) 19 (45.2) 0.151 2.06 1 No 29 (40.8) 23 (54.8) ↵Values are presented as numbers and percentages (%), mean ± standard deviation (SD), or median and interquartile range (IQRs). The comparisons of numerical variables between groups were analyzed with the independent-sample t-test and the Mann-Whitney-U test according to the distribution of data. The comparisons of categorical variables between groups were analyzed with the Chi-square (χ2) test.
↵* A p-value of < 0.05 was considered significant.
COVID-19: coronavirus disease-19, CVC: central venous catheterization, APACHE: acute physiology and chronic health evaluation, χ2: Ki-kare, df: degree of freedom
- Table 2
- Distribution of Candida species isolated from coronavirus disease-19 positive and coronavirus disease-19 negative patients.
Candida species COVID-19 (+) COVID-19 (-) P-value χ2 df C. parapsilosis 14 (19.7) 25 (59.5) 0.0001* 29.87 7 C. glabrata 5 (7.0) 4 (9.5) C. albicans 38 (53.5) 4 (9.5) C. tropicalis 4 (5.6) 5 (11.9) C. spp 7 (9.9) 1 (2.4) C. kefyr 1(1.4) 1 (2.4) C. krusei 1 (1.4) 1 (2.4) C. lusitaniae 1 (1.4) 1 (2.4) Total 71 (100) 42 (100) Values are presented as numbers and percentages (%). The comparisons of categorical variables between groups were analyzed with the Chi-square (χ2) test.
↵* A p-value of <0.05 was considered significant.
COVID-19: coronavirus disease-19, χ2: Ki-kare, df: degree of freedom, C.: Candida
- Table 3
- Distribution of susceptible antifungals in coronavirus disease-19 positive and coronavirus disease-19 negative patients.
Antifungal COVID-19 (+) COVID-19 (-) P-value χ2 df Anidulafungin 70 (98.5) 41 (97.6) 0.164 6.51 4 Caspofungin 68 (95.7) 41 (97.6) Vorikonazol 60 (84.5) 23 (54.7) Micafungin 69 (97.1) 41 (97.6) Flukonazol 50 (70.4) 15 (35.7) Values are presented as numbers and percentages (%). COVID-19: coronavirus disease-19, χ2: Ki-kare, df: degree of freedom
- Table 4
- Distribution of antifungal susceptibilities of Candida species isolated from coronavirus disease-19 positive (group 1) and coronavirus disease-19 negative (group 2) patients.
Candida species Anidulafungin Caspofungin Vorikonazol Micafungin Flukonazol Group 1 Group 2 Group 1 Group 2 Group 1 Group 2 Group 1 Group 2 Group 1- Group 2 C. parapsilosis 13 (18.6) 25 (61) 12 (17.6) 25 (61) 10 (16.7) 14 (60.9) 13 (18.8) 25 (61) 2 (4.0) - 4 (22.2) C. glabrata 5 (7.1) 4 (9.8) 5 (7.4) 4 (9.8) 3 (5) 2 (8.7) 5 (7.2) 4 (9.8) 3 (6.0) - 3 (16.6) C. albicans 38 (54.3) 4 (9.8) 37 (54.4) 4 (9.8) 35 (58.3) 4 (17.4) 37 (53.6) 4 (9.8) 35 (70.0) - 4 (22.2) C. tropicalis 4 (5.7) 4 (9.8) 4 (5.9) 4 (9.8) 2 (3.3) 2 (8.7) 4 (5.8) 4 (9.8) 4 (8.0) - 3 (16.6) C. spp 7 (10) 1 (2.4) 7 (10.3) 1 (2.4) 7 (11.7) 0 (0.0) 7 (10.1) 1 (2.4) 6 (12.0) - 2 (11.1) C. kefyr 1 (1.4) 1 (2.4) 1 (1.5) 1 (2.4) 1 (1.7) 0 (0.0) 1 (1.4) 1 (2.4) 0 (1.0) - 1(5.5) C. krusei 1 (1.4) 1 (2.4) 1 (1.5) 1 (2.4) 1 (1.7) 1 (4.3) 1 (1.4) 1 (2.4) 0 (1.0) - 1(5.5) C. lusitaniae 1 (1.4) 1 (2.4) 1 (1.5) 1 (2.4) 1 (1.7) 0 (0.0) 1 (1.4) 1 (2.4) 0 (0.0) - 0(0.0) Total 70 (100) 41 (100) 68 (100) 41 (100) 60 (100) 23 (100) 69 (100) 41 (100) 50 (100) - 18 (100) Values are presented as numbers and percentages (%). P-value of 0.600, χ2=25.51, df=28. The comparisons of categorical variables between groups were analyzed with the Chi-square (χ2) test (a p-value of <0.05 was considered significant).
C.: Candida, χ2: Ki-kare, df: degree of freedom
- Table 5
- Distribution of Gram (+) and Gram (-) bacterial species accompanying Candida infection isolated from coronavirus disease-19 positive and coronavirus disease-19 negative patients.
Gram bacteria species COVID-19 (+) COVID-19 (-) P-value χ2 df Gram (+) bacteria species Coagulase-negative Staphylococci 5 (33.3) 4 (66.6) 0.024* 16.10 7 Enterococcus faecium 8 (53.3) 0 (0.0) Enterococcus spp 2 (13.3) 2 (33.3) Total 15 (100) 6 (100) Gram (-) bacteria species Acinetobacter spp 13 (36.1) 7 (28) 0.131 11.18 7 Klebsiella spp 15 (41.7) 10 (40) Escherichia coli 2 (5.6) 0 (0.0) Pseudomonas spp 2 (5.6) 6 (24) Stenotrophomonas maltophilia 1 (2.8) 0 (0.0) Proteus spp 0 (0.0) 2 (8) Klebsiella spp + Pseudomonas 1 (2.8) 0 (0.0) Klebsiella spp + Acinetobacter 2 (5.6) 0 (0.0) Total 36 (100) 25 (100) Values are presented as numbers and percentages (%). The comparisons of categorical variables between groups were analyzed with the Chi-square (χ2) test. A p-value of <0.05 was considered significant.
COVID-19: coronavirus disease-19, χ2: Ki-kare, df: degree of freedom
- Table 6
- Comparisons of the laboratory data between coronavirus disease-19 positive and coronavirus disease-19 negative patients.
Variables Group 1 Group 2 P-values WBC (10/uL) 14.16 (7.92-17.89) 8.45 (6.09-17.28) 0.03* HGB (g/dL) 9.6 (8.6-11.7) 8.7 (8.0-9.4) 0.0003* PLT (10/uL) 168.000 (86.000-277.000 153.000 (94.750-449.000) 0.593 Procalcitonin (ng/mL) 1.49 (0.46-4.58) 2.21 (0.79-5.32) 0.206 CRP (mg/L), mean±SD 155.2±79.2 163.5±99.2 0.625 Creatinine (mg/dL) 0.97 (0.70-1.83) 0.90 (0.69-1.90) 0.816 AST (U/L) 30 (28-79) 30.5 (18-64.5) 0.04* ALT (U/L) 32 (28-72) 16 (10.3-53.3) 0.0002* WBC: white blood cell, HGB: hemoglobin, PLT: platelet, CRP: C-reactive protein, AST: aspartate aminotransferase, ALT: alanine aminotransferase, Group 1: coronavirus disease positive, Group 2: coronavirus disease negative
↵Normally distributed data are presented as mean ± standard deviation (SD) and not normally distributed data were expressed as median and interquartile range (IQRs). The comparisons of data between groups were analyzed with the independent-sample t-test and the Mann-Whitney-U test according to the distribution of data.
↵* A p-value of <0.05 was considered significant.
Antifungal agents Susceptible Susceptible dose dependent Intermediate Resistant Fluconazole* ≤8 16-32 ≥64 Itraconzole ≤0.125 0.25-0.5 ≥1 Flucytosine ≤4 8-16 ≥32 Caspofungin ≤2*† Voriconazole <1 >4 ↵* Candida krusei recovered from super infections have not been found to be susceptible to fluconazole and may require alternative antifungal therapy.
† In clinical studies, voriconazole MIC90 for C. glabrata baseline was 4 ug/ml; 13/50 (26%). C. glabrata baseline isolates were resistant (MIC ≥4ug/ml) to voriconazole. However, based on 1054 isolates tested in surveillance studies the MIC90 was 1 ug/ml.
- Appendix 2
- Minimum inhibitory concentration interpretative criteria for Candida species as per Clinical and Laboratory Standards Institute M27.
Antifungal agents Susceptible Susceptible dose dependent Intermediate Resistant Non-susceptible Anidulafungin ≤2 >2 Caspofungin ≤2 >2 Fluconazole* ≤8 16-32 ≥64 5-Flucytosine ≤4 8-16 ≥32 Itraconzole ≤0.125 0.25-0.5 ≥1 Micafungin ≤2 >2 Voriconazole ≤1 2 ≥4