Impact of COVID-19 and earthquake disaster on candidemia in the ICU: mortality and treatment outcomes

BACKGROUND: Candidemia is a serious bloodstream infection with high mortality, particularly in intensive care unit (ICU) patients. Its epidemiology is influenced by evolving practices, resistance, and extraordinary circumstances such as pandemics and disasters. This study aimed to analyze candidemia epidemiology, risk factors, and outcomes, focusing on the impact of the COVID-19 pandemic and a major earthquake in southern Turkey. METHODS: We retrospectively analyzed 739 adult ICU patients diagnosed with candidemia between 2018 and 2023 at a tertiary referral center in Turkey. Patients were grouped as pre-pandemic, COVID-19, and post-earthquake periods. Clinical characteristics, Candida species distribution, antifungal treatment timing, and mortality rates were compared. Logistic regression was performed to identify independent predictors of 30-day mortality. RESULTS: There was a total of 739 documented cases, including 261 (35.32%) during the pre-pandemic period, 305 (41.27%) during the COVID-19 period, and 173 (23.41%) during the earthquake period. The overall 30-day mortality rate was 67.52%. Mortality was significantly higher during the COVID-19 period (78.36%) compared to the pre-pandemic (57.47%) and post-earthquake (63.58%) periods (p < 0.001). Non-albicans Candida species accounted for 70.77% of isolates, with C. parapsilosis being most frequent. Delayed initiation of antifungal therapy (> 48 h) and prolonged indwelling catheter duration were associated with increased mortality. Multivariable analysis identified higher Charlson comorbidity index, Candida score, septic shock, mechanical ventilation, and delayed antifungal therapy as independent predictors of mortality (AUC = 0.765). CONCLUSION: Candidemia in ICU patients is associated with high mortality, particularly under crisis conditions such as the COVID-19 pandemic and earthquake disaster. Early antifungal initiation and prompt catheter removal remain critical to improving outcomes. These findings highlight the need for strengthened infection control strategies and disaster preparedness in a resource-challenged setting. CLINICAL TRIAL REGISTRATION: Not applicable.