Assessment of incidence and risk factors of COVID-19-associated candidemia using diagnosis procedure combination data

Patients with coronavirus disease 2019 (COVID-19) develop various complications including infections from other microorganisms. COVID-19-associated invasive fungal infections are important complications, which include aspergillosis, mucormycosis, and candidiasis [1]. The incidence of candidemia has been reported to be up to ten times higher in patients with than in patients without COVID-19 [[1], [2], [3]], and this may be because patients with COVID-19 have many factors that can put them at risk of candidemia, including iatrogenic immunosuppression, antibiotic drug use, and intensive care unit admission [[4], [5], [6], [7], [8]]. Furthermore, candidemia has high mortality rate and is associated with prolonged hospital stay and high medical costs; high mortality rate has also been noted in patients with COVID-19 [[9], [10], [11]]. The number of COVID-19 cases, treatment situations, and treatment approaches, as well as characteristics of candidemia in patients with COVID-19, may differ across countries. However, only a few studies exist on candidemia in patients with COVID-19 in Asia [2,12], and to our knowledge, no epidemiological investigations have been conducted using large-scale data. Specifically, no studies have been conducted in Japan regarding candidemia in patients with COVID-19. Therefore, many advanced treatment hospitals in Japan introduced diagnosis procedure combination (DPC), a patient classification system for insurance calculations [[13], [14], [15]], and we used this data to estimate the incidence, risk factors, a mortality risk of candidemia in patients with COVID-19.

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