Study of the Outcome of Invasive Fungal Infection Complicating ICU Patients of Community Acquired Pneumonia of A Tertiary Care Hospital of Eastern India – A Randomised Controlled Trial

INTRODUCTION: Fungi that infiltrate the body's tissues and organs can cause devastating, perhaps fatal diseases known as invasive fungal infections (IFIs)(1). The fungi that cause IFIs include Candida, Aspergillus, Cryptococcus, Pneumocystis, Blastomyces, Histoplasma, Paracoccidioides, and Coccidioides. These fungi are frequently present in the environment.(1–3) Risk factors: Individuals with compromised immune systems, such as those who have received organ transplants, cancer, or HIV/AIDS, are more vulnerable to IFIs.(1,4) Burn patients, those on long-term immunosuppressive treatment, and people with chronic respiratory conditions are additional risk factors.(1,2,7,8,9) OBJECTIVES: To evaluate the complications and overall hospital outcomes of ICU patients of community acquired pneumonia cases with and without associated invasive fungal infections. MATERIAL AND METHODS: A total of 40 ICU patients, 20 in each group viz – community acquired pneumonia with invasive fungal infection (IFI) and without invasive fungal infections were included. BAL GALACTOMANNAN level (more than 2) along with the risk factors of invasive fungal infections were used to diagnose the ICU patients with invasive fungal infection. IFI patients were treated with the anti-fungals in addition with the broad spectrum anti-microbials. The primary outcome was to study the overall length of ICU stay, invasive mechanical ventilation need and overall mortality. RESULTS: The overall sample size is 40, 20 patients in each group viz-community acquired pneumonia with and without invasive fungal infection. Among 20 patients (mean age-63.3±2) who were admitted with community acquired pneumonia without invasive fungal infections (IFI) mean ICU length of stay was 8.04 (±2.5) days whereas in the group with invasive fungal infections the mean length of stay was 12.30 (±1.2). 3 patients without IFIs and 7 patients with IFI stayed in ICU for more than 21 days. The requirement of invasive mechanical ventilation was 22.1% in Non-IFI group whereas in IFIs group it was 25.2%. The mechanical ventilator free days were more in non IFIs group-5.2 days compared to IFIs group 3.75 days. The overall mortality was higher in IFIs group – 33.7% whereas in non IFIs group- 22.1% as predicted by admission time APACHE-IV score. CONCLUSIONS: The overall ICU length of stay and admission day predicted APACHE-IV based mortality was higher in IFIs group compared to the non-IFIs group whereas the requirement of invasive mechanical ventilation was comparable in both the groups. The invasive mechanical ventilator free days were more in non-IFI group compared to IFI group.