Abstract
Comprehensive data on emerging invasive fungal infections (EIFIs) in the critically ill are scarce. We conducted a case-control study to characterize EIFIs in patients admitted to a French medical ICU teaching hospital from 2006 to 2019. Among 6900 patients, 26 (4 per 1000) had an EIFI: Mucorales accounted for half, and other isolates were mainly Saprochaete, Fusarium and Scedosporium. EIFIs occurred mostly in patients with immunosuppression and severe critical illness. Antifungal treatments (mainly amphotericin B) were administered to almost all patients, whereas only 19% had surgery. In-ICU, mortality was high (77%) and associated with previous conditions such as hematological malignancy or cancer, malnutrition, chronic kidney disease and occurrence of acute respiratory distress syndrome and/or hepatic dysfunction. Day-90 survival rates, calculated by the Kaplan–Meier method, were similar between patients with EIFIs and a control group of patients with aspergillosis: 20%, 95% CI (9- 45) versus 18%, 95% CI (8- 45) (log-rank: p > 0.99). ICU management of such patients should be assessed on the basis of underlying conditions, reversibility and acute event severity rather than the mold species.
Highlights
IntroductionFungal infections are life-threatening opportunistic infections that have emerged as a major cause of morbidity and mortality in critically ill patients
Given that 6900 patients were admitted in our ICU concomitantly, incidence of emerging invasive fungal infections (EIFIs) was at 4 per 1000 admissions (Figure 1)
We found that main factors associated with mortality were (1) previous status including prior hematological malignancy or cancer, chronic kidney disease and malnutrition; and (2) the occurrence of an acute respiratory distress syndrome (ARDS) or a hepatic dysfunction during ICU stay
Summary
Fungal infections are life-threatening opportunistic infections that have emerged as a major cause of morbidity and mortality in critically ill patients. Mainly Candida spp., remain much more frequent than mold infections [1]. Aspergillus spp. represent the most frequently isolated filamentous fungi in these circumstances [1]. Other filamentous fungi, such as Mucorales, Fusarium, Scedosporium or Saprochaete have emerged over recent years in patients with hematologic malignancies or bone marrow transplants and may be underestimated [2]
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