Abstract
The epidemiology of invasive fungal infections (IFI) is ever evolving. The aim of the present study was to analyze the clinical, microbiological, susceptibility, and outcome data of IFI in Indian patients to identify determinants of infection and 30-day mortality. Proven and probable/putative IFI (defined according to modified European Organization for Research and Treatment of Cancer/Mycoses Study Group and AspICU criteria) from April 2017 to December 2018 were evaluated in a prospective observational study. All recruited patients were antifungal naïve (n = 3300). There were 253 episodes of IFI (7.6%) with 134 (52.9%) proven and 119 (47%) probable/putative infections. There were four major clusters of infection: invasive candidiasis (IC) (n = 53, 20.9%), cryptococcosis (n = 34, 13.4%), invasive aspergillosis (IA) (n = 103, 40.7%), and mucormycosis (n = 62, 24.5%). The significant risk factors were high particulate efficiency air (HEPA) room admission, ICU admission, prolonged exposure to corticosteroids, diabetes mellitus, chronic liver disease (CLD), acquired immunodeficiency syndrome (AIDS), coronary arterial disease (CAD), trauma, and multiorgan involvement (p < 0.5; odds ratio: >1). The all-cause 30-day mortality was 43.4% (n = 110). It varied by fungal group: 52.8% (28/53) in IC, 58.8% (20/34) in cryptococcosis, 39.8% (41/103) in IA, and 33.9% (21/62) in mucormycosis. HEPA room, ICU admission for IC; HEPA rooms, diabetes mellitus for cryptococcosis; hematological malignancies, chronic kidney disease (CKD), sepsis, galactomannan antigen index value ≥1 for IA and nodules; and ground glass opacities on radiology for mucormycosis were significant predictors of death (odds ratio >1). High minimum inhibitory concentration (MIC) values for azoles were observed in C. albicans, C. parapsilosis, C. glabrata, A. fumigatus, A. flavus, R. arrhizus, R. microsporus, and M. circinelloides. For echinocandin, high MIC values were seen in C. tropicalis, C. guillermondii, C. glabrata, and A. fumigatus. This study highlights the shift in epidemiology and also raises concern of high MICs to azoles among our isolates. It warrants regular surveillance, which can provide the local clinically correlated microbiological data to clinicians and which might aid in guiding patient treatment.
Highlights
Invasive fungal infections (IFIs) continue to represent a significant problem in immunocompromised individuals and a large proportion of critically ill patients [1]
Three thousand and three hundred patients suspected of IFIs were recruited in the study, of which 253 (253/3300, 7.6%) (52%, 134/253 proven and 48%, 119/253 probable/putative IFIs) presented with 65.6%, 166/253 mold and 34.4%, 87/253 yeast IFIs
Species domination was by Candida albicans and Candida parapsilosis (26.4% each, 14/53) in invasive candidiasis cases, study, of which 253 (253/3300, 7.6%)
Summary
Invasive fungal infections (IFIs) continue to represent a significant problem in immunocompromised individuals and a large proportion of critically ill patients [1]. This changing epidemiology with increasing numbers of immunocompetent hosts includes the cases following natural disasters and large iatrogenic inoculation [1,2]. Scedosporium sp., phaeohyphomycetes (darkly pigmented or dematiaceous fungi), and basidiomycetous yeasts (Trichosporon sp., Malassezia sp.) known to cause these infections in different populations [12] These fungi affect various tissues throughout the body, with the respiratory system being the most common [13]. These infections can present as coinfections, further complicating and delaying the diagnosis [13]
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