# P-1736. Temporal Shifts in Candidemia Epidemiology in Costa Rica: Pre-Pandemic, Pandemic, and Post-Pandemic Analysis (2007-2023)

## TL;DR

This study shows how the incidence and species distribution of candidemia in Costa Rica changed before, during, and after the COVID-19 pandemic.

## Contribution

The study identifies the pandemic as a turning point in candidemia epidemiology, with a shift in dominant Candida species.

## Key findings

- Candidemia incidence increased during the pandemic and decreased afterward.
- C. parapsilosis dominance declined while C. albicans became the most common species post-pandemic.
- Mixed candidemia cases emerged after 2021, reaching 5.6% by 2023.

## Abstract

The epidemiology of candidemia has shown significant variations over time. This study examines the impact of the COVID-19 pandemic on candidemia patterns in Costa Rica.Incidence of CandidemiaIncidence of Candidemia in Costa Rica (2007-2023)Temporal EvolutionTemporal Evolution of Main Candida Species (2007-2023)

Incidence of Candidemia

Incidence of Candidemia in Costa Rica (2007-2023)

Temporal Evolution

Temporal Evolution of Main Candida Species (2007-2023)

We analyzed 2,128 candidemia cases from two tertiary hospitals in Costa Rica across three distinct periods: pre-pandemic (2007-2019, n=1,658), pandemic (2020-2021, n=256), and post-pandemic (2022-2023, n=214).

Candidemia incidence showed significant temporal variations: increasing from 0.119/100 discharges (2007) to 0.283/100 (2014), followed by fluctuations until rising significantly during the pandemic (0.266/100 discharges vs. 0.205/100 pre-pandemic), and subsequently decreasing post-pandemic (0.193/100). The pandemic marked a critical inflection point in species distribution (χ²=73.41, p< 0.001). C. parapsilosis dominance (47.8% pre-pandemic) diminished progressively (40.6% during pandemic, 29.0% post-pandemic), while C. albicans increased (29.7%, 35.2%, and 40.2%, respectively). C. tropicalis showed sustained increases from pre-pandemic (7.8%) to post-pandemic periods (14.5%). Mixed candidemia cases increased from none (2007-2010) to 5.6% (2023), with notable absence during 2021.

The COVID-19 pandemic represents a significant inflection point in candidemia epidemiology in Costa Rica, with persistent post-pandemic shifts in species distribution. The emergence of C. albicans as the dominant species over C. parapsilosis post-pandemic represents a significant epidemiological transition with important clinical implications for empirical treatment strategies and infection control practices.

All Authors: No reported disclosures