Emerging Invasive Fungal Infections in Critically Ill Patients: Incidence, Outcomes and Prognosis Factors, a Case-Control Study

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.

Keywords: Chaetomium; Fusarium; Saccharomyces; Saprochaete; Scedosporium; Trichosporon; intensive care unit; invasive fungal infections; mucormycosis; outcome.

Figure 1

Flow chart of the study population.

Figure 2

Kaplan–Meier curve of day-90 survival after ICU admission of 26 patients with emerging invasive fungal infections (red line) and 26 patients with aspergillosis (blue dashed line). Emerging invasive fungal infections (EIFIs): Mucorales (n = 13), Saprochaete (n = 6), Trichosporon (n = 1), Fusarium (n = 2), Scedosporium (n = 2), Chaetomium (n = 1), Saccharomyces (n = 1). 95% CI: 95% confidence interval.