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.

Nivolumab and interferon-γ rescue therapy to control mixed mould and bacterial superinfection after necrotizing fasciitis and septic shock

“…The patient’s immunological status (i.e., low mHLA-DR and high PD-1 lymphocyte expression) allowed us to target the innate and adaptive component of immunity dysfunction using both IFN-γ and nivolumab as previously reported in a young patient who died from refractory mucormycosis after sustaining bomb blast injuries [ 5 ]. Data on the control of such invasive infections and outcomes in ICU patients are scarce [ 7 , 8 ], although we can hypothesise that such immunotherapy has improved the anti-fungi response as described in the case of Turnbull et al [ 1 ].…”

Scedosporium boydii disseminated infection complicating severe SARS-CoV2 infection in an immunocompetent patient: a case report

“…(6) Invasive fungal infections (IFIs) by molds in general are an emerging condition in critically ill patients, with associated mortality rates that can be up to 70%. (7)The most common etiologic agents are Aspergillus or Mucorales spp. ; however, infections by less common molds such as Fusarium and Scedosporium spp., have been reported.…”

Deep Fungal Infections Among General Hospital Inpatients in Southwestern China: A 5-Year Retrospective Study

“…The common pathogens of deep fungal infections are Aspergillus and Cryptococcus rank after Candida ( 3 ). In recent years, some rare filamentous fungi such as Mucor and Fusarium have been reported from time to time in patients with hematological malignancies and bone marrow transplantation ( 11 ). In this study, we conducted a retrospective analysis of the status of deep fungal infections in the First Affiliated Hospital of Kunming Medical University from January 2015 to December 2019.…”