Publication date: Oct 18, 2024

Limited data is available concerning the patterns of antifungal use and invasive fungal infection (IFI)-associated mortality risk factors prior to and during the COVID-19 pandemic in a resource-limited setting. A single center retrospective cohort study was conducted to evaluate the patterns of antifungal use and IFI-associated mortality risk factors in a resource-limited setting prior to and during the COVID-19 pandemic. All patients age >18 years diagnosed with IFI were prospectively followed during a 3-year pre-COVID-19 pandemic period (period 1: 1/1/2017-12/31/2019) and a 3-year during COVID-19 pandemic period (period 2: 1/1/2020-12/31/2022). Patient characteristics, patterns of antifungal use, IFI-associated mortality risk factors, and adverse drug events were collected. Multivariate analysis was performed to identify IFI-associated mortality risk factors. There was a total of 133 patients in this study: 60 (45. 1%) in period 1 and 73 (54. 9%) in period 2. Pre-emptive antifungal therapy was commonly practiced in period 2 (21. 7% vs 37%, p=0. 05). The presence of a central venous catheter (CVC) (aOR 3. 19, p=0. 007), hematologic adverse drug events (aOR 17. 9, p=0. 008) were potentially preventable risks for the overall IFI mortality in both periods. Appropriate antifungal use was protective against the overall IFI mortality in period 2 (aOR 0. 09, p=0. 009). Several preventable IFI-associated mortality risk factors including the presence of CVC and inappropriate antifungal use were identified and served as key target changes for improvement of infection prevention, national policy to access appropriate antifungal agents, and antifungal stewardship in a resource-limited setting during the COVID-19 pandemic.

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Original Article