A recent study published in the Emerging Infectious Diseases Journal examined hospitalizations for fungal infections during the coronavirus disease 2019 (COVID-19) pandemic in the United States (US).
Study: Increased Hospitalizations Involving Fungal Infections during COVID-19 Pandemic, United States, January 2020–December 2021. Image Credit: Tyler Olson/Shutterstock.com
Fungal infections impose significant healthcare costs in the US. Risk factors are variable but are generally associated with environmental exposure and underlying immunocompromising or immunosuppressive conditions.
COVID-19 is a considerable risk factor for some fungal infections. Data from the US vital statistics indicate increased deaths from fungal infections during the COVID-19 pandemic. However, data on healthcare utilization and hospitalizations are unavailable.
The study and findings
In the present study, researchers determined healthcare utilization and hospitalization rates for fungal infections in the US during the COVID-19 pandemic.
They analyzed an extensive database of healthcare services that comprised de-identified records from over 1,000 hospitals and identified hospitalizations for COVID-19 and fungal infections in 2021, using the International Classification of Diseases, Tenth Revision, and Clinical Modification (ICD-10-CM) codes.
The team defined COVID-19-related fungal hospitalization as one in which both fungal infection and COVID-19 were diagnosed during the same hospitalization. They computed annual hospitalization rates by the type of fungal infection.
The average annual percent change in hospitalization rates between 2019 and 2021 was also calculated. Further, rates for COVID-19-related fungal hospitalizations (in 2020-21 only) were estimated per 10,000 COVID-19 hospitalizations.
Fungal hospitalizations in 2020-21 were stratified by infection type and COVID-19 status. Patient demographics, hospitalization durations, admissions to intensive care units (ICUs), use of mechanical ventilation, and in-hospital mortality were analyzed.
The team used Cochran-Armitage and chi-squared tests to assess and compare hospitalization trends by COVID-19 status. There were over 59,000 fungal hospitalizations during 2019-21.
Fungal hospitalization rates were 22.3, 25, and 26.8 per 10,000 hospitalizations in 2019, 2020, and 2021, respectively. On average, the annual percent change in hospitalization rates was 8.5%.
Hospitalization rates significantly increased yearly for all fungal infections, except those due to Cryptococcus spp. and Pneumocystis spp. In 2020-21, COVID-19-associated fungal hospitalizations accounted for 13.4% of fungal hospitalizations, and the rate increased annually by about 25%.
Significant increases in annual rates of COVID-19-related fungal hospitalizations were observed for blastomycosis, aspergillosis, mucormycosis, pneumocystosis, histoplasmosis, and other mycoses.
Aspergillosis and mucormycosis were more frequently associated with COVID-19-related fungal hospitalizations than hospitalizations unrelated to COVID-19. The median age of patients was 61 for non-COVID-19 fungal hospitalizations and 63 for COVID-19-related fungal hospitalizations.
COVID-19-associated fungal hospitalizations mainly occurred in males, Latino or Hispanic individuals, and Western US hospitals and involved longer stays in the hospital, with an increased need for ICU and mechanical ventilation.
In-hospital deaths were also higher for fungal hospitalizations associated with COVID-19. Aspergillosis, mucormycosis, invasive candidiasis, and other mycoses caused higher in-hospital deaths among COVID-19-related fungal hospitalizations.
In sum, significant increases in fungal hospitalizations occurred in the US from 2019 to 2021, mainly driven by those associated with COVID-19. In 2020-21, 13.8% of fungal hospitalizations were related to COVID-19 and caused around two- and four-fold increases in ICU admissions and in-hospital deaths, respectively.
Overall, the findings highlight the burden and surge of fungal hospitalizations during the COVID-19 pandemic.