Mould infections in Indian ICUs

J Crit Care. 2019 Feb 5;51:64-70

Contributed by Dr Abi Manesh

This important study gives information on mould infections from Indian ICUs- their epidemiology, presentations and outcomes. The authors studied 41879 subjects admitted in ICU at the 11 participating centres. In essence, they diagnosed definitive mould infection when there was histopathological evidence showing fungal hyphae and probable when there is indirect evidence (galactomanan positivity, culture or cytology showing fungal hyphae).

They concluded that there were 398 cases (proven 96, probable 302) of IMI amounting to a prevalence of 9.5 (range, 4.3-29.0) cases per 1000 ICU admissions. The classical (neutropenic patients and transplant hosts) and nonclassical risk factor groups with IMI consisted of 145 (36.4%) and 253 (63.6%) of subjects, respectively. Lung and sinus involvement where the dominant presentation. Diabetes mellitus and lung diseases (influenza, COPD, asthma and interstitial lung diseases) were the dominant predisposing non classical risk factors. There were no specific radiological clues to suspect fungal infections in patients with non classical risk factors). Almost two third of patients with mould infections died. High APACHE II score and IMI due to mucormycosis were predictors of mortality after adjusting for the type of risk factor (classic vs. non-classic), the need for dialysis and the time from ICU admission to the diagnosis of IMI.

High clinical suspicion for mould infections in patients with non classical risk factors (DM and respiratory problems) may result in prompt treatment initiation and better outcomes.