Epidemiology and risk factors of fungal pathogens in sepsis: a prospective nationwide multicenter cohort study.

Summary

In a nationwide cohort of 11,981 septic adults, fungal pathogens were identified in 3.4%, dominated by Candida spp., yet only 6.6% received antifungal therapy. Chronic kidney disease, immunocompromised status, connective tissue disease, and invasive mechanical ventilation were independently associated with fungal identification; oncologic status did not significantly alter outcomes.

Key Findings

• Fungal pathogens were identified in 3.4% (407/11,981) of sepsis cases; Candida albicans (47.9%), C. glabrata (20.6%), and C. tropicalis (13.5%) predominated.
• Only 6.6% of patients with confirmed fungal pathogens received antifungal therapy, indicating a major treatment gap.
• Independent associations with fungal identification included CKD (OR 1.662), connective tissue disease (OR 1.885), immunocompromised status (OR 2.284), and invasive mechanical ventilation (OR 2.864).
• Hemato-oncologic malignancy did not significantly affect outcomes among those with fungal pathogens.

Clinical Implications

Consider early fungal diagnostics and timely antifungal therapy in septic patients with CKD, immunocompromise, connective tissue disease, or requiring invasive ventilation. Integrate stewardship to address marked underuse of antifungals.

Limitations

• Findings reflect patients with identified fungal pathogens; underdiagnosis may bias prevalence estimates.
• Generalizability may be limited to health systems similar to South Korea; antifungal underuse reasons were not dissected.

Future Directions

Implement and evaluate rapid fungal diagnostics and stewardship algorithms in high-risk sepsis; assess outcome impact of protocolized early antifungal initiation.