Invasive fungal infections in a paediatric intensive care unit in a lower- middle-income country

Abstract

Background. Paediatric intensive care units (PICUs) are high-risk settings for healthcare-associated infections. Invasive fungal infection (IFI) is one of the common causes of healthcare-associated infections. Objective. To describe the prevalence and short-term outcomes of children with IFI, and to offer a basis for the efficient prevention and treatment of IFI. Methods. A retrospective study was conducted in children under the age of 12 years over a two-year period. Participants were categorised according to pre-defined microbiology criteria into IFI if they had a positive culture from blood or other sterile sites. Data collected included demographics, invasive procedures, length of stay and mortality. Results. One thousand and forty-two children were admitted during the study period. Of the total, 56.8% (n = 592) were male. Median length of stay was 18 days (mean ± SE 18.6±8.9). IFI was identified in 35 cases per 1 000 admissions, with 77.7% of these infants under the age of one year. The mean length of stay was 18.6 days compared with 7.5 days for children with bacterial infections. The in-hospital mortality for invasive fungal infection was 36% compared with 16% for all admissions. Findings confirmed that colonisation was more prevalent than IFI. Conclusion. IFIs are common among infants, and these patients have a higher mortality rate and prolonged hospital stay. Therefore we recommend early diagnosis and timely treatment with high-performance antifungal drugs to improve the prognosis in children with IFI. Keywords. Healthcare-associated infections, South Africa, neonates, mortality, sepsis.