Evaluation of Clinical, Microbiological Profiles and Management Patterns with Outcomes of Patients with Fungal Isolates in An Intensive Care Unit of A Tertiary Care Center: A Prospective Observational Study

INTRODUCTION: Infections remain a significant burden in intensive care units (ICUs), with fungal infections posing a particular challenge. Reports indicate an incidence of fungal infections ranging from 0.22–4.1% in developing countries and 0.024–0.687% in developed nations. Early symptoms of fungal bloodstream infections are often non-specific, while low culture-positive rates lead to frequent misdiagnosis. Addressing these challenges necessitates the establishment of advanced diagnostic mycology laboratories, rapid diagnostic techniques, and tailored antifungal strategies, particularly in India. AIMS AND OBJECTIVES: This study aims. AIMS AND OBJECTIVES: Our aim is to evaluate clinical, microbiological profiles and management patterns with outcomes of patients with fungal isolates. MATERIAL AND METHODS: The prospective observational study was conducted at a single centre, enrolling patients based on predefined inclusion and exclusion criteria. Risk factors for fungal infections were assessed, and only patients with positive fungal cultures were included. Outcome was assessed based on ventilator use, vasopressor use ICU stay duration, and discharge status. RESULTS: Among 120 patients, the mean age was 53 ± 15 years, with females accounting for 45.6%. Diabetes mellitus was the most prevalent risk factor (50%), followed by chronic liver disease (17.4%). Urine samples revealed fungal infections in 37.8% of cases, predominantly caused by Candida tropicalis (61%). Resistance patterns varied significantly among isolates, with fluconazole resistance being most common (37%). Total parenteral nutrition was administered to 22% of patients, 31% of whom were infected with Candida albicans. While urinary catheterization was associated with fungal isolates, no significant associations were observed for other ICU interventions. Patients required ventilation for an average of 3 ± 3 days and vasopressor support for 4 ± 4.5 days. The mean ICU stay was seven days. Outcomes showed 64% of patients were shifted to the ward, 14% expired, and 22% were discharged. Patients who died often had Candida auris isolated. Additionally, 15% of patients had a colonization index >0.5. Candida scores varied, with most patients scoring 2 (56.7%), followed by scores of 3 (21.7%), 4 (12.5%), and 5 (8.3%). CONCLUSION: The study indicates that while fungal isolates exhibit different infection characteristics (e.g., site of isolation and resistance patterns), these differences do not translate to significant disparities in demographic factors, ICU interventions (other than catheterization), or clinical outcomes. The prevalence of fluconazole resistance across isolates highlights the need for careful antifungal stewardship and the consideration of alternative treatment options tailored to resistance profiles.