Fungal Infections Are Not Associated with Increased Mortality in COVID‐19 Patients Admitted to Intensive Care Unit (ICU)

Ainsworth, James; Sewell, Peter; Eggert, Sabine; Morris, Keith; Pillai, Suresh Gopala

doi:10.1155/2023/4037915

Journal article 160 views 25 downloads

Fungal Infections Are Not Associated with Increased Mortality in COVID‐19 Patients Admitted to Intensive Care Unit (ICU)

James Ainsworth

, Peter Sewell, Sabine Eggert, Keith Morris, Suresh Gopala Pillai

Critical Care Research and Practice, Volume: 2023, Issue: 1

Swansea University Author: Suresh Gopala Pillai

PDF | Version of Record

Copyright © 2023 James Ainsworth et al. This is an open access article distributed under the Creative Commons Attribution License.
Download (494.45KB)

Check full text

DOI (Published version): 10.1155/2023/4037915

Abstract

Introduction. Fungal infection is a cause of increased morbidity and mortality in intensive care patients. Critically unwell patients are at increased risk of developing invasive fungal infections. COVID-19 patients in the intensive care unit (ICU) may be at a particularly high risk. The primary aim...

Full description

Published in:	Critical Care Research and Practice
ISSN:	2090-1305 2090-1313
Published:	Wiley 2023
Online Access:	Check full text
URI:	https://cronfa.swan.ac.uk/Record/cronfa70780

first_indexed	2025-10-28T16:01:36Z
last_indexed	2025-11-14T12:47:33Z
id	cronfa70780
recordtype	SURis
fullrecord	<?xml version="1.0"?><rfc1807><datestamp>2025-11-13T12:35:04.1799353</datestamp><bib-version>v2</bib-version><id>70780</id><entry>2025-10-28</entry><title>Fungal Infections Are Not Associated with Increased Mortality in COVID‐19 Patients Admitted to Intensive Care Unit (ICU)</title><swanseaauthors><author><sid>f567f8d5db61d62ef08e811676fd8430</sid><ORCID>0000-0002-9753-6949</ORCID><firstname>Suresh</firstname><surname>Gopala Pillai</surname><name>Suresh Gopala Pillai</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2025-10-28</date><deptcode>MEDS</deptcode><abstract>Introduction. Fungal infection is a cause of increased morbidity and mortality in intensive care patients. Critically unwell patients are at increased risk of developing invasive fungal infections. COVID-19 patients in the intensive care unit (ICU) may be at a particularly high risk. The primary aim of this study was to establish the incidence of secondary fungal infections in patients admitted to the ICU with COVID-19. Secondary aims were to investigate factors that may contribute to an increased risk of fungal infections and to calculate the mortality between fungal and nonfungal groups. Methods. We undertook a retrospective observational study in a tertiary ICU in Wales, United Kingdom. 174 patients admitted with COVID-19 infection from March 2020 until May 2021 were included. Data were collected through a retrospective review of patient’s clinical notes and microbiology investigation results obtained from the online clinical portal. Results. 81/174 (47%) COVID-19 patients developed fungal infections, 93% of which were Candida species, including Candida albicans (88%), and 6% had an Aspergillus infection. Age and smoking history did not appear to be contributing factors. The nonfungal group had a significantly higher body mass index (33 ± 8 vs. 31 ± 7, p = 0.01). The ICU length of stay (23 (1–116) vs. 8 (1–60), p < 0.001), hospital length of stay (30 (3–183) vs. 15 (1–174) ± 7, p < 0.001), steroid days (10 (1–116) vs. 4 (0–28), p = 0.02), and ventilation days (18 (0–120) vs. 2 (0–55), p < 0.001) were significantly higher in the fungal group. The mortality rate in both groups was similar (51% vs. 52%). The Kaplan–Meier survival analysis showed that the fungal group survived more than the nonfungal group (log rank (Mantel–Cox), p < 0.001). Conclusion. Secondary fungal infections are common in COVID-19 patients admitted to the ICU. Longer treatment with corticosteroids, increased length of hospital and ICU stay, and greater length of mechanical ventilation significantly increase the risk of fungal infections. Fungal infection, however, was not associated with an increase in mortality.</abstract><type>Journal Article</type><journal>Critical Care Research and Practice</journal><volume>2023</volume><journalNumber>1</journalNumber><paginationStart/><paginationEnd/><publisher>Wiley</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>2090-1305</issnPrint><issnElectronic>2090-1313</issnElectronic><keywords/><publishedDay>1</publishedDay><publishedMonth>1</publishedMonth><publishedYear>2023</publishedYear><publishedDate>2023-01-01</publishedDate><doi>10.1155/2023/4037915</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>Another institution paid the OA fee</apcterm><funders/><projectreference/><lastEdited>2025-11-13T12:35:04.1799353</lastEdited><Created>2025-10-28T09:39:33.9301597</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Biomedical Science</level></path><authors><author><firstname>James</firstname><surname>Ainsworth</surname><orcid>0000-0001-5571-1983</orcid><order>1</order></author><author><firstname>Peter</firstname><surname>Sewell</surname><order>2</order></author><author><firstname>Sabine</firstname><surname>Eggert</surname><order>3</order></author><author><firstname>Keith</firstname><surname>Morris</surname><order>4</order></author><author><firstname>Suresh</firstname><surname>Gopala Pillai</surname><orcid>0000-0002-9753-6949</orcid><order>5</order></author></authors><documents><document><filename>70780__35617__a8a3aa29634648fdb5f68bd5ea0b373f.pdf</filename><originalFilename>70780.VoR.pdf</originalFilename><uploaded>2025-11-13T12:33:33.8507670</uploaded><type>Output</type><contentLength>506313</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>Copyright © 2023 James Ainsworth et al. This is an open access article distributed under the Creative Commons Attribution License.</documentNotes><copyrightCorrect>true</copyrightCorrect><language>eng</language><licence>http://creativecommons.org/licenses/by/4.0/</licence></document></documents><OutputDurs/></rfc1807>
spelling	2025-11-13T12:35:04.1799353 v2 70780 2025-10-28 Fungal Infections Are Not Associated with Increased Mortality in COVID‐19 Patients Admitted to Intensive Care Unit (ICU) f567f8d5db61d62ef08e811676fd8430 0000-0002-9753-6949 Suresh Gopala Pillai Suresh Gopala Pillai true false 2025-10-28 MEDS Introduction. Fungal infection is a cause of increased morbidity and mortality in intensive care patients. Critically unwell patients are at increased risk of developing invasive fungal infections. COVID-19 patients in the intensive care unit (ICU) may be at a particularly high risk. The primary aim of this study was to establish the incidence of secondary fungal infections in patients admitted to the ICU with COVID-19. Secondary aims were to investigate factors that may contribute to an increased risk of fungal infections and to calculate the mortality between fungal and nonfungal groups. Methods. We undertook a retrospective observational study in a tertiary ICU in Wales, United Kingdom. 174 patients admitted with COVID-19 infection from March 2020 until May 2021 were included. Data were collected through a retrospective review of patient’s clinical notes and microbiology investigation results obtained from the online clinical portal. Results. 81/174 (47%) COVID-19 patients developed fungal infections, 93% of which were Candida species, including Candida albicans (88%), and 6% had an Aspergillus infection. Age and smoking history did not appear to be contributing factors. The nonfungal group had a significantly higher body mass index (33 ± 8 vs. 31 ± 7, p = 0.01). The ICU length of stay (23 (1–116) vs. 8 (1–60), p < 0.001), hospital length of stay (30 (3–183) vs. 15 (1–174) ± 7, p < 0.001), steroid days (10 (1–116) vs. 4 (0–28), p = 0.02), and ventilation days (18 (0–120) vs. 2 (0–55), p < 0.001) were significantly higher in the fungal group. The mortality rate in both groups was similar (51% vs. 52%). The Kaplan–Meier survival analysis showed that the fungal group survived more than the nonfungal group (log rank (Mantel–Cox), p < 0.001). Conclusion. Secondary fungal infections are common in COVID-19 patients admitted to the ICU. Longer treatment with corticosteroids, increased length of hospital and ICU stay, and greater length of mechanical ventilation significantly increase the risk of fungal infections. Fungal infection, however, was not associated with an increase in mortality. Journal Article Critical Care Research and Practice 2023 1 Wiley 2090-1305 2090-1313 1 1 2023 2023-01-01 10.1155/2023/4037915 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University Another institution paid the OA fee 2025-11-13T12:35:04.1799353 2025-10-28T09:39:33.9301597 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Biomedical Science James Ainsworth 0000-0001-5571-1983 1 Peter Sewell 2 Sabine Eggert 3 Keith Morris 4 Suresh Gopala Pillai 0000-0002-9753-6949 5 70780__35617__a8a3aa29634648fdb5f68bd5ea0b373f.pdf 70780.VoR.pdf 2025-11-13T12:33:33.8507670 Output 506313 application/pdf Version of Record true Copyright © 2023 James Ainsworth et al. This is an open access article distributed under the Creative Commons Attribution License. true eng http://creativecommons.org/licenses/by/4.0/
title	Fungal Infections Are Not Associated with Increased Mortality in COVID‐19 Patients Admitted to Intensive Care Unit (ICU)
spellingShingle	Fungal Infections Are Not Associated with Increased Mortality in COVID‐19 Patients Admitted to Intensive Care Unit (ICU) Suresh Gopala Pillai
title_short	Fungal Infections Are Not Associated with Increased Mortality in COVID‐19 Patients Admitted to Intensive Care Unit (ICU)
title_full	Fungal Infections Are Not Associated with Increased Mortality in COVID‐19 Patients Admitted to Intensive Care Unit (ICU)
title_fullStr	Fungal Infections Are Not Associated with Increased Mortality in COVID‐19 Patients Admitted to Intensive Care Unit (ICU)
title_full_unstemmed	Fungal Infections Are Not Associated with Increased Mortality in COVID‐19 Patients Admitted to Intensive Care Unit (ICU)
title_sort	Fungal Infections Are Not Associated with Increased Mortality in COVID‐19 Patients Admitted to Intensive Care Unit (ICU)
author_id_str_mv	f567f8d5db61d62ef08e811676fd8430
author_id_fullname_str_mv	f567f8d5db61d62ef08e811676fd8430_***_Suresh Gopala Pillai
author	Suresh Gopala Pillai
author2	James Ainsworth Peter Sewell Sabine Eggert Keith Morris Suresh Gopala Pillai
format	Journal article
container_title	Critical Care Research and Practice
container_volume	2023
container_issue	1
publishDate	2023
institution	Swansea University
issn	2090-1305 2090-1313
doi_str_mv	10.1155/2023/4037915
publisher	Wiley
college_str	Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id	facultyofmedicinehealthandlifesciences
hierarchy_top_title	Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id	facultyofmedicinehealthandlifesciences
hierarchy_parent_title	Faculty of Medicine, Health and Life Sciences
department_str	Swansea University Medical School - Biomedical Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Biomedical Science
document_store_str	1
active_str	0
description	Introduction. Fungal infection is a cause of increased morbidity and mortality in intensive care patients. Critically unwell patients are at increased risk of developing invasive fungal infections. COVID-19 patients in the intensive care unit (ICU) may be at a particularly high risk. The primary aim of this study was to establish the incidence of secondary fungal infections in patients admitted to the ICU with COVID-19. Secondary aims were to investigate factors that may contribute to an increased risk of fungal infections and to calculate the mortality between fungal and nonfungal groups. Methods. We undertook a retrospective observational study in a tertiary ICU in Wales, United Kingdom. 174 patients admitted with COVID-19 infection from March 2020 until May 2021 were included. Data were collected through a retrospective review of patient’s clinical notes and microbiology investigation results obtained from the online clinical portal. Results. 81/174 (47%) COVID-19 patients developed fungal infections, 93% of which were Candida species, including Candida albicans (88%), and 6% had an Aspergillus infection. Age and smoking history did not appear to be contributing factors. The nonfungal group had a significantly higher body mass index (33 ± 8 vs. 31 ± 7, p = 0.01). The ICU length of stay (23 (1–116) vs. 8 (1–60), p < 0.001), hospital length of stay (30 (3–183) vs. 15 (1–174) ± 7, p < 0.001), steroid days (10 (1–116) vs. 4 (0–28), p = 0.02), and ventilation days (18 (0–120) vs. 2 (0–55), p < 0.001) were significantly higher in the fungal group. The mortality rate in both groups was similar (51% vs. 52%). The Kaplan–Meier survival analysis showed that the fungal group survived more than the nonfungal group (log rank (Mantel–Cox), p < 0.001). Conclusion. Secondary fungal infections are common in COVID-19 patients admitted to the ICU. Longer treatment with corticosteroids, increased length of hospital and ICU stay, and greater length of mechanical ventilation significantly increase the risk of fungal infections. Fungal infection, however, was not associated with an increase in mortality.
published_date	2023-01-01T05:30:27Z
_version_	1851369799411564544
score	11.089572

Fungal Infections Are Not Associated with Increased Mortality in COVID‐19 Patients Admitted to Intensive Care Unit (ICU)

Similar Items