Analysis of invasive fungal infections observed in the intensive care units of Sakarya training and research Hospital

Introduction and Objective: Fungal infections are a significant health concern, particularly among patients in intensive care units (ICUs). These infections, frequently observed in immunocompromised patients, substantially increase mortality and morbidity rates. This study aimed to retrospectively analyze the clinical, epidemiological, and microbiological data of patients diagnosed with invasive fungal infections in the ICU of Sakarya Training and Research Hospital between 2018 and 2023 to provide a comprehensive evaluation. Methods: In this retrospective study, data from 128 ICU patients diagnosed with IFIs between 2018 and 2023 were analyzed. Clinical conditions such as candidemia, catheter-related infections, and mortality were assessed. Patient demographics, admission diagnoses, comorbidities, risk factors, isolated fungal species, and treatment outcomes were extracted from the database and analyzed. Results: High rates of bacterial infection (82.8%), broad-spectrum antibiotic use (93.8%), sepsis (80.5%), and mechanical ventilation requirement (86.7%) were observed as risk factors. Fungal growth was detected on average at 30.6 days, with 84.4% of cultures obtained from blood and 10.2% from urine samples. The most commonly isolated fungal species was C. albicans (39.8%), followed by C. parapsilosis (27.3%), C. glabrata (14.8%), and C. tropicalis (9.4%). Within the first month following fungal growth, 69.5% of patients had died. Comorbidities and COVID-19 positivity were associated with mortality. Patients with higher mortality rates had significantly lower empirical antifungal therapy initiation, new antifungal treatments, and antifungal treatment duration, while steroid/chemotherapy use, renal replacement therapy, and inotropic support were significantly higher. Mechanical ventilation and sepsis rates were higher, and hospital stays were shorter in the mortality group. Univariate analysis showed that comorbidities, antifungal therapy duration, albumin, CRP, neutrophil and platelet counts, and MV rates significantly impacted mortality. Multivariate analysis identified antifungal therapy duration, neutrophil and platelet levels, and MV requirement as independent predictors of mortality. Conclusion: IFIs, particularly candidemia, are a significant cause of mortality and morbidity in ICUs. Our findings align with other ICU studies in Turkey, highlighting central venous catheter presence, mechanical ventilation, and broad-spectrum antibiotic use as key risk factors for candidemia. Mortality predictors included antifungal therapy duration, neutrophil and platelet counts, and MV requirement. These findings emphasize the importance of early diagnosis, effective treatment management, and improved infection control measures.