Prescribing Practices of Antifungal Therapy in a Mixed Icu- a Prospective Observational Study

As per the  recent trend fungal infections in ICU are becoming increasingly common. This is complicated by high mortality, especially in invasive fungal infections. Early diagnosis and initiation of antifungals is the standard of care which is limited by limitation in rapid diagnostic tests. Hence empiric and pre-emptive antifungal treatment are common and are the prescribing practices along with definitive therapy which usually delays the initiation of treatment. There is a recent emergence of resistant fungal infections among ICU patients, and we have limited number of antifungal agents which can be useful in ICU population. They are also very expensive. Bacterial and fungal infections in ICU share similar clinical picture which further complicates and delay the diagnosis. This study aimes to study the factors influencing initiation and choice of antifungal therapy in critically ill patients based on clinical profile, biomarkers and culture or histopathological data. primary objectives was to To identify the factors leading to initiation of antifungal therapy in ICU including patient’s clinical profile, biomarkers and histopathology or cultures. The secondary objectives would be To study the pattern of antifungal prescription in ICU, To evaluate the types of fungal infection in ICU and diagnostic modalities being used and Outcomes of patients with fungal infections in ICU (ICU length of stay,  hospital mortality and     28-day mortality). Methodology of study will be those patients admitted in St John’s Medical College Hospital ICU who are eligible based on the inclusion and exclusion criteria will be enrolled in the study.  All patients initiated on antifungal therapy in ICU will be recruited. Reason for initiation of antifungals will be collected based on proforma. Clinical profile will be recorded, APACHE II score will be calculated, Commonly associated comorbidities (Charlson comorbidity index) will be entered. Relevant data for diagnosing fungal infection will be collect from patient records  including Specimen microscopic examination for fungal elements, biomarkers – galactomannan (GM), β-D glucan, appropriate Imaging leading to diagnosis of fungal infection – (eg:CT thorax), PCR test (eg: Biofire panel, meningoencephalitis panel etc), fungal cultures (body fluids/tissue), is to pathology from tissues or Source/sources of fungus isolated will be collected. Antifungals used and duration of treatment along with Outcomes of patients with fungal infections in ICU aslo will be collected.