The battle against fungi: lessons in antifungal stewardship from COVID 19 times

The COVID-19 pandemic has highlighted the detrimental effect of secondary pathogens in patients with a primary viral insult. In addition to superinfections with bacterial pathogens, invasive fungal infections were increasingly reported. The diagnosis of pulmonary fungal infections has always been challenging; however, it became even more problematic in the setting of COVID-19, particularly regarding the interpre-tation of radiological findings and mycology test results in patients with these infections. Moreover, pro-longed hospitalization in ICU, coupled with underlying host factors. such as preexisting immunosuppres-sion, use of immunomodulatory agents, and pulmonary compromise, caused additional vulnerability to fungal infections in this patient population. In addition, the heavy workload, redeployment of untrained staff, and inconsistent supply of gloves, gowns, and masks during the COVID-19 outbreak made it harder for healthcare workers to strictly adhere to preventive measures for infection control. Taken together, these factors favored patient-to-patient spread of fungal infections, such as those caused by Candida au-ris, or environment-to-patient transmission, including nosocomial aspergillosis. As fungal infections were associated with increased morbidity and mortality, empirical treatment was overly used and abused in COVID-19-infected patients, potentially contributing to increased resistance in fungal pathogens. The aim of this paper was to focus on essential elements of antifungal stewardship in COVID-19 for three fungal infections, COVID-19-associated candidemia (CAC),-pulmonary aspergillosis (CAPA), and-mucormycosis (CAM). & COPY; 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license ( http://creativecommons.org/licenses/by/4.0/ )

Automated summary

The detrimental effect of secondary pathogens, including invasive fungal infections, in COVID-19 patients is highlighted. The diagnosis of pulmonary fungal infections becomes more challenging during the pandemic, especially regarding radiological findings and mycology test results interpretation. Prolonged hospitalization in ICU, coupled with underlying host factors, increases vulnerability to fungal infections. The heavy workload, redeployment of untrained staff, and inconsistent supply of protective equipment make strict adherence to infection control measures difficult for healthcare workers.