Predictors and outcomes of patients with COVID-19 admitted to Intensive Care Units in Pakistan and the development of nosocomial fungal infections: findings and implications

Background: Patients with COVID-19 admitted to ICUs typically have many complications and co-morbidities, including secondary bacterial and fungal infections, which increase morbidity and mortality. The first step to address this is measure prevalence rates, predictors of fungal infections, and outcomes of COVID-19 patients admitted to ICUs in Pakistan. Methods: Retrospective review of medical records of patients admitted with COVID-19 to the ICUs of six tertiary care hospitals between March 2020 to June 2023. Results: 636 patients were included, 68.9% aged ≥ 50 and 62.6% male. Diabetes mellitus was the commonest co-morbidity (23.7%). 67.8% of patients were suffering from severe COVID-19, with 23% critical. Antibiotics and antipyretics (all patients) were the most frequently prescribed medicines along with corticosteroids (72.5%). 63 nosocomial fungal infections developed in 53 patients, with mechanical ventilation and tracheal intubation significant predictors of secondary fungal infections among COVID-19 patients. The mortality rate was 4.9%, with secondary fungal infections significantly associated with higher mortality. Conclusion: Approximately 8% of patients with COVID-19 admitted to ICUs developed secondary fungal infections associated with greater mortality. Key factors associated with secondary fungal infections need to be carefully monitored to reduce future mortality in these patients. We will continue to monitor the situation.