New data from a US hospital database show a significant increase in hospitalizations involving fungal infections from 2019 through 2021, driven primarily by COVID-19–associated infections, US researchers reported yesterday in Emerging Infectious Diseases.
Using data from the Premier Healthcare Database, Special COVID-19 Release, researchers from the Centers for Disease Control and Prevention (CDC) identified 59,212 fungal hospitalizations over the 3-year period. Rates of fungal hospitalizations (per 10,000 hospitalizations) increased from 22.3 in 2019 to 25.0 in 2020 and 26.8 in 2021, for an average annual change of 8.5%. Among the specific fungal pathogens that saw increases were Candida, Aspergillus, Coccidioides, and Histoplasma.
During 2020-2021, 13.4% of 39,423 fungal hospitalizations were related to COVID-19. Rates of COVID-19–associated fungal hospitalizations increased by 24.9%. Compared with non-COVID-19–associated fungal hospitalizations, COVID-19–associated fungal hospitalizations more frequently involved aspergillosis (27.8% vs 16.9%), mucormycosis (1.8% vs 1.4%), and unspecified mycoses (24.3% vs 18.5%). The median patient age for COVID-19–associated hospitalizations was 63.
Regardless of the pathogens involved, COVID-19–associated fungal infections more frequently involved longer hospital stays, higher intensive care unit admission rates (a fourfold increase), more invasive mechanical ventilation receipts, and a higher in-hospital death rate (twofold increase) than non-COVID-19–associated fungal infections. COVID-19–associated fungal hospitalizations with the highest percentage of deaths involved aspergillosis (57.6%), invasive candidiasis (55.4%), mucormycosis (44.7%), and unspecified mycoses (59.0%).
"Our analysis underscores the substantial burden of patient hospitalizations with fungal infections in the United States and indicates that increased hospitalizations involving fungal infections occurred during the COVID-19 pandemic," the CDC researchers wrote. "As the COVID-19 pandemic evolves, and to increase preparedness for future infectious diseases outbreaks, comprehensive public health surveillance for fungal diseases is needed to characterize disease epidemiology and guide efforts to prevent illness and death."