INTRODUCTION: Patients with COVID-19 may develop concomitant viral, bacterial or fungal infections. Such patients have a higher risk of death, especially in critical illness. Although much attention has been recently given to fungal infections that may have devastating consequences, data on this issue is scarce. METHODS: We systematically searched for studies that focused on critically ill adults who were diagnosed with COVID-19 and fungal co-infection. Mortality was the outcome of interest. The search was conducted within MEDLINE, Web of Science, clinicaltrials.gov, Embase and Cochrane Library on 8 January 2022. RESULTS: We reviewed 38 papers covering 17,695 patients, 1182 (6.7%) of whom had an acquired fungal infection. The overall mortality in papers retrieved for a systematic review (n=38) varied from 29 to 100% (median=56%; IQR 40-77%). In a meta-analysis (19 studies), patients with fungal infection were more likely to die than the controls (OR=2.987; 95% CI 2.369 - 3.767; p<0.001; I2 = 26.63%). Subgroup analyses showed that COVID-19-associated pulmonary aspergillosis (CAPA) increased mortality by 3 times (OR=3.279; 95%CI 2.692 - 3.994; p<0.001; I2 = 0%) and that COVID-19-associated candidiasis (CAC) increased mortality by 2 times (OR=2.254; 95%CI 1.322- 3.843; I2=26.14%). CONCLUSIONS: In critically ill patients with COVID-19, CAPA is rather common and significantly increases mortality. The evidence regarding other fungal infections is weaker, however, CAC occurs less frequently but impacts mortality. Therefore, clinical awareness and screening are needed, followed by personalized antifungal therapy stewardship, which is strongly recommended in order to improve patients' prognosis.
- All age groups
- Risk factor
- COVID-19
