Abstract / Summary
Summary: Background: Invasive fungal infections (IFIs) are challenging to treat in critical care, particularly among patients treated in Intensive care units (ICUs). The existing evidence on IFIs from India remains fragmented. This study characterises IFI incidence, risk factors, resistance pattern, treatment and outcome among patients admitted to ICUs. Methods: This multicentre observational study leveraged registry data on IFIs among patients admitted to 63 ICUs in eight Advanced Mycology Diagnostic and Research centres in India between January 2023 and November 2025. Patients with proven and probable IFI according to European Organisation for Research and Treatment of Cancer/Mycoses Study Group Education and Research Consortium (EORTC/MSGERC) 2020 and the modified Aspergillus intensive care unit (AspICU) 2020 criteria were included. IFI incidence to hospital admission, all-cause in-hospital mortality, pathogen distribution and antifungal susceptibility were recorded. Mortality-associated factors were estimated using multivariable logistic regression and Cox proportional hazards analysis. Findings: Among 178,417 ICU admissions, 2500 IFI patients were identified with an incidence of 14/1000 admissions (95% CI 13.5–14.6) and all-cause mortality of 53.6% (95% CI 51.7–55.6%). Invasive candidiasis was the most frequently reported (57.1%), followed by invasive aspergillosis (37%), mucormycosis (3.4%), trichosporonosis (1.8%), pneumocystis pneumonia (1.1%), and cryptococcosis (1.2%). Median age of the patients was 45 years (IQR: 26–60), with 61.9% males and 38.1% females. Among candidiasis, Candida tropicalis predominated (35.6%), while Candida auris exhibited high fluconazole resistance (61.7%) and elevated amphotericin B minimum inhibitory concentrations (MICs) (40.7%). Aspergillus fumigatus (50.8%) and Aspergillus flavus (38.7%) predominated among culture-positive aspergillosis, with generally low MICs. Exploratory multivariable analyses showed that sepsis, chronic liver disease, immunosuppression, corticosteroid exposure, and total parenteral nutrition were associated with higher mortality in invasive candidiasis, whereas mechanical ventilation, corticosteroid exposure, and immunosuppression were associated with higher mortality in invasive aspergillosis. Interpretation: The study findings highlight a high IFI burden and mortality among patients admitted in ICUs of India, with mortality exceeding 50%, underscoring the need for continuous surveillance, rapid diagnostics, infection control and antifungal stewardship. Funding: This study was funded by the Indian Council of Medical Research (ICMR), Delhi (Grant ID: 157401).