(830) Invasive Fungal Disease in the Pediatric Intensive Care Unit of a Developing Country

Introduction: Children admitted to pediatric intensive care units (PICU) can have multiple risk factors making them vulnerable to developing hospital-acquired invasive fungal diseases (IFD). The aim of this study was to analyze the epidemiology and risk factors for development of IFD and mortality in children admitted to PICU.

Methods: It was a retrospective case-control study conducted in a pediatric intensive tertiary care setting from January 2010 to October 2019. Cases were defined as patients having IFD. Controls were patients matched with i) PICU length of stay ± 3 days ii) patients admitted in PICU during the same time period (±2 weeks) as that of the case. Data was analyzed using adjusted odd ratio (AOR), Chi-squared, and T-test with a p-value of < 0.05 as significant.

Results: Total 74 cases were identified matched with 109 with overall mean age of 5.8±5.9 years. Immunocompromised status [AOR 3.098(1.162 - 8.262) CI 95% p0.024], 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% p0.001] and evidence of a recent bloodstream infection [AOR 3.699(1.596 - 8.576) CI 95% p0.002] had significant positive correlation with invasive fungal disease, while injectable antibacterial Cefazolin [AOR 0.28(0.105 - 0.747) CI 95% p0.011] and presence neurological diagnosis [AOR 0.249(0.09 - 0.687) CI 95% p0.249] had significant negative correlation with invasive fungal disease. Among IFD patients, male gender [AOR 9.358 (1.943 - 45.073) CI 95% p0.005], 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% p0.009] had significant positive correlation with mortality, while the length of stay of more than 6 days [AOR 0.157(0.027 - 0.901) CI 95% p0.038] had significant negative correlation with mortality.

Conclusions: Our study highlights that the immunocompromised status, presence of foley catheter, and injectable Meropenum usage are significantly associated with IFD, while male gender, presence of shock, and injectable Azithromycin usage predict high mortality among IFD patients. Therefore emphasizing need for awareness among healthcare providers regarding invasive fungal infections prevention strategies in pediatric patients.