Epidemiology and risk factors of invasive fungal disease in pediatric intensive care unit of a developing country

Healthcare associated infections (HAI) are potentially preventable causes of morbidity and mortality in particularly low and low-middle income countries (LMIC). Children admitted to pediatric intensive care units (PICU) can have multiple risk factors making them vulnerable to develop HAI especially invasive fungal diseases (IFD). Aim of this study was to analyze the epidemiology of IFD in the PICU and pediatric cardiac intensive care units (PCICU) and to identify the risk factors associated with mortality among patients with IFD. Patients and methods It was a retrospective case-control study conducted in the PICU and PCICU at the Aga Khan university hospital. Cases were defined as patients having invasive fungal disease. Characteristics including age, gender, risk factors like presence of co-morbid conditions, use of steroids, proton pump inhibitors, mechanical ventilation, hemodialysis, broad-spectrum antibiotics, total parenteral nutrition, presence of foley catheter, peritoneal dialysis catheter, central venous line, neutropenia, bacteremia or having recent intra-abdominal surgery were assessed. Results Total 183 children were enrolled (109 in non-IFD and 74 in IFD group). Immunocompromised status [AOR 3.098 (1.162–8.262) CI 95% p 0.024], presence of Foley catheter [AOR 7.147 (2.413–21.163) CI 95% p < 0.001], usage of injectable antibacterial Meropenum [AOR 4.029 (1.714–9.471) CI 95% p 0.001] and evidence of a recent blood stream infection [AOR 3.699 (1.596–8.576) CI 95% p 0.002] had significant positive correlation with invasive fungal disease, while injectable antibacterial Cefazolin [AOR 0.28 (0.105–0.747) CI 95% p 0.011] and presence neurological diagnosis [AOR 0.249 (0.09–0.687) CI 95% p 0.249] had significant negative correlation with invasive fungal disease. Among IFD patients, male gender [AOR 9.358 (1.943–45.073) CI 95% p 0.005], presence of shock [AOR 26.146 (4.5–151.93) CI 95% p < 0.001] and usage of Injectable antibacterial Azithromycin [AOR 11.722 (1.852–74.171) CI 95% p 0.009] had significant positive correlation with mortality, while the length of stay of more than 06 days [AOR 0.157 (0.027–0.901) CI 95% p 0.038] had significant negative correlation with mortality. Conclusion We conclude that the immunocompromised status, presence of foley catheter and injectable Meropenum usage is significantly associated with IFD, while male gender, presence of shock and injectable Azithromycin usage predict high mortality among IFD patients.