A retrospective Italian analysis on the characteristics of invasive fungal infections in the intensive care unit setting: CHARTER‐IFI study

Abstract Background Invasive fungal infections (IFI), prevalent in critically ill ICU patients, have gained attention due to post‐COVID‐19 epidemiological shifts. Notably, COVID‐19‐associated aspergillosis and candidiasis pose significant risks. WHO recognises key fungal pathogens, emphasising the need for enhanced research and interventions. Methods The CHARTER‐IFI study retrospectively examines 186,310 individuals admitted to ICUs in Italy from 01/01/2012–01/09/2023, utilising administrative databases covering around 10 million inhabitants. Adult patients were included having at least one ICU discharge diagnosis of IFI at their first IFI‐related hospitalisation and having at least 12 months of available data prior to this hospitalisation. Results A total of 746 IFI patients discharged from ICU (incidence of 4.0 per 1000 ICU‐hospitalised patients), were included. Median age was 68 years, 63% were males, and the overall Charlson Comorbidity Index was 2.2. The top three diagnoses were candidiasis ( N = 501, 2.7/1000 ICU‐hospitalised patients), aspergillosis ( N = 71, 0.4/1000), and pneumocystosis ( N = 55, 0.3/1000). The evaluation of the comorbidity profile in IFI patients revealed the presence of hypertension (60.5%), use of systemic GC/antibacterials (45.3% during 12 months before and 18.6% during 3 months before hospital admission), cancer (23.1%), diabetes (24.3%) and cardiovascular diseases (23.9%). The mean (±SD) length of hospitalisation in ICU was 19.9 ± 24.1 days (median 11 days), and deaths occurred in 36.1% of IFI patients (within 30 days from discharge). Conclusions This retrospective analysis among ICU‐hospitalised patients described the burden of IFI in ICU, and its understanding could be crucial to strengthen surveillance, investments in research, and public health interventions as required by WHO.