{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T08:20:10Z","timestamp":1763367610599,"version":"3.40.5"},"reference-count":36,"publisher":"BMJ","issue":"5","license":[{"start":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T00:00:00Z","timestamp":1685404800000},"content-version":"unspecified","delay-in-days":29,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004319","name":"Pfizer Inc.","doi-asserted-by":"crossref","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}],"id":[{"id":"10.13039\/100004319","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>To investigate the impact of COVID-19 on the burden of hospital-treated<jats:italic>Aspergillus<\/jats:italic>and<jats:italic>Candida<\/jats:italic>infections in England.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>A retrospective study using Hospital Episodes Statistics data to estimate the burden of serious and invasive fungal infections (SIFIs) in all patients admitted in England during March 2018\u2013February 2020 (pre-COVID-19) and during March 2020\u2013October 2021 (the COVID-19 period).<\/jats:p><\/jats:sec><jats:sec><jats:title>Setting<\/jats:title><jats:p>Hospitals in England.<\/jats:p><\/jats:sec><jats:sec><jats:title>Population<\/jats:title><jats:p>All patients with codes corresponding to serious and invasive aspergillosis and candidiasis in any diagnosis position during their admission pre-COVID-19 and during the COVID-19 period.<\/jats:p><\/jats:sec><jats:sec><jats:title>Outcome measures<\/jats:title><jats:p>Age, spells, patient counts, mean length of stay, admission to critical care unit (CCU), length of stay in CCU, 30-day readmissions, failed discharges (readmission within 7 days) and comorbidities.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the COVID-19 period, hospitalisation spells with an invasive candidiasis code fell by 3.2% and spells with an aspergillosis code by 24.8%. Mean length of stay was higher for patients with aspergillosis with or without COVID-19 and candidiasis with or without COVID-19 during the pandemic than before the pandemic. During the pandemic, mean length of stay was higher for patients with aspergillosis with COVID-19 than those with aspergillosis alone but slightly lower for patients with candidiasis with COVID-19 than for those with candidiasis alone. Of patients with a diagnosis of COVID-19, 52.5% with aspergillosis and 60.0% with candidiasis were treated in CCU compared with 13.2% and 37.1%, respectively, without a COVID-19 diagnosis. The percentage of 30-day readmissions and failed discharges for patients with SIFI was higher for those with COVID-19 than for those without.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The burden of aspergillosis and candidiasis has been affected by COVID-19. Aspergillosis diagnoses fell among hospitalised patients during the pandemic, while candidiasis continued to fluctuate in patterns similar to pre-COVID-19. A higher burden for patients with SIFI was observed, whether or not they also had a diagnosis of COVID-19. Our findings highlight extra considerations and burden on management of serious SIFI as a result of the COVID-19 pandemic.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2022-070537","type":"journal-article","created":{"date-parts":[[2023,5,30]],"date-time":"2023-05-30T15:01:09Z","timestamp":1685458869000},"page":"e070537","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Hospital-treated serious and invasive aspergillosis and candidiasis infections during the COVID-19 pandemic: a retrospective analysis of Hospital Episode Statistics data from England"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7365-8562","authenticated-orcid":false,"given":"Anita H","family":"Sung","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4991-5151","authenticated-orcid":false,"given":"Gillian","family":"Kiely","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9722-0795","authenticated-orcid":false,"given":"Jyotika K","family":"Singh","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4309-2219","authenticated-orcid":false,"given":"Stephen","family":"Thomas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1980-3877","authenticated-orcid":false,"given":"Jemma","family":"Lough","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2342-9921","authenticated-orcid":false,"given":"Matthew","family":"Smith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2023,5,30]]},"reference":[{"key":"2023053008001558000_13.5.e070537.1","first-page":"71","article-title":"Invasive fungal infections in patients with COVID-19: a review on pathogenesis, epidemiology, clinical features, treatment, and outcomes","volume":"44","author":"Chiurlo","year":"2021","journal-title":"New Microbiol"},{"key":"2023053008001558000_13.5.e070537.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2020.02.025"},{"key":"2023053008001558000_13.5.e070537.3","doi-asserted-by":"publisher","DOI":"10.1542\/pir.2017-0129"},{"key":"2023053008001558000_13.5.e070537.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2015.10.015"},{"key":"2023053008001558000_13.5.e070537.5","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1016\/j.idc.2021.03.007","article-title":"Candidemia and invasive candidiasis","volume":"35","author":"McCarty","year":"2021","journal-title":"Infect Dis Clin North Am"},{"key":"2023053008001558000_13.5.e070537.6","doi-asserted-by":"publisher","DOI":"10.1007\/s00134-020-06240-x"},{"key":"2023053008001558000_13.5.e070537.7","doi-asserted-by":"crossref","first-page":"18026","DOI":"10.1038\/nrdp.2018.26","article-title":"Invasive candidiasis","volume":"4","author":"Pappas","year":"2018","journal-title":"Nat Rev Dis Primers"},{"key":"2023053008001558000_13.5.e070537.8","unstructured":"Public Health England . 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