Invasive Fungal Diseases in Hospitalized Patients with COVID-19 in Israel: A Multicenter Cohort Study

Meital Elbaz, Maya Korem, Oshrat Ayalon, Yonit Wiener-Well, Yael Shachor-Meyouhas, Regev Cohen, Jihad Bishara, Alaa Atamna, Tal Brosh-Nissimov, Nir Maaravi, Lior Nesher, Bibiana Chazan, Sharon Reisfeld, Oren Zimhony, Michal Chowers, Yasmin Maor, Eugene Katchman, Ronen Ben-Ami*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Highly variable estimates of COVID-19-associated fungal diseases (IFDs) have been reported. We aimed to determine the incidence of clinically important fungal diseases in hospitalized COVID-19 patients during the first year of the pandemic. We performed a multicenter survey of IFDs among patients hospitalized with COVID-19 in 13 hospitals in Israel between February 2020 and May 2021. COVID-19-associated pulmonary mold disease (PMD) and invasive candidiasis (IC) were defined using ECMM/ISHAM and EORTC/MSG criteria, respectively. Overall rates of IC and PMD among patients with critical COVID-19 were 10.86 and 10.20 per 1000 admissions, respectively, with significant variability among medical centers. PMD rates were significantly lower in centers where galactomannan was a send-out test versus centers with on-site testing (p = 0.035). The 30-day mortality rate was 67.5% for IC and 57.5% for PMD. Treatment with an echinocandin for IC or an extended-spectrum azole for PMD was associated with significantly lower mortality rates (adjusted hazard ratio [95% confidence interval], 0.26 [0.07–0.91] and 0.23 [0.093–0.57], respectively). In this multicenter national survey, variable rates of PMD were associated with on-site galactomannan testing, suggesting under-detection in sites lacking this capacity. COVID-19-related IFDs were associated with high mortality rates, which were reduced with appropriate antifungal therapy.

Original languageEnglish
Article number721
JournalJournal of Fungi
Issue number7
StatePublished - Jul 2022


FundersFunder number
Israel Science Foundation442/18
Ministry of Science and Technology, Israel88555


    • Aspergillus
    • COVID-19
    • Candida
    • critical care
    • epidemiology


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