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

Zia Ul Mustafa; Aneeqa Suleman; Muhammad Faiq Masood; Muhammad Salman; Aftab Nazir; Tauqeer Hussain Malhi; Yusra Habib Khan; Steward  Mudenda; Johanna C. Meyer; Brian Godman; R. Andrew Seaton

doi:10.1016/j.ijregi.2024.100445

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

Zia Ul Mustafa, Aneeqa Suleman, Muhammad Faiq Masood, Muhammad Salman, Aftab Nazir, Tauqeer Hussain Malhi, Yusra Habib Khan, Steward Mudenda, Johanna C. Meyer, Brian Godman^*, R. Andrew Seaton

^*Corresponding author for this work

Strathclyde Institute Of Pharmacy And Biomedical Sciences

Research output: Contribution to journal › Article › peer-review

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Abstract

Objectives: Patients with COVID-19 admitted to intensive care units (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 to measure the prevalence rates, predictors of fungal infections, and outcomes of patients with COVID-19 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 in Pakistan between March 2020 and June 2023. Results: A total of 636 patients were included; 68.9% were aged ≥50 years and 62.6% were male. Diabetes mellitus was the commonest co-morbidity (23.7%). A total of 67.8% of patients had severe COVID-19, with 23% critical cases. Antibiotics and antipyretics (all patients) were the most frequently prescribed medicines, along with corticosteroids (72.5%). A total of 63 nosocomial fungal infections developed in 53 patients, with mechanical ventilation and tracheal intubation being significant predictors of secondary fungal infections among patients with COVID-19. The mortality rate was 4.9%, with secondary fungal infections significantly associated with higher mortality. Conclusions: Approximately 8% of patients with COVID-19 admitted to the ICUs of tertiary developed secondary fungal infections associated with greater mortality. The 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.

Original language	English
Article number	100445
Number of pages	6
Journal	IJID Regions
Volume	13
Early online date	7 Sept 2024
DOIs	https://doi.org/10.1016/j.ijregi.2024.100445
Publication status	Published - 31 Dec 2024

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Ethical approval for the study was obtained from the Office of Research, Innovation and Commercialization, Lahore College for Women University, Jail Road, Lahore. Moreover, ethical approval of the current study was also obtained from all the relevant institutions. Because patient data were being collected retrospectively from medical records and notes, with no data collected directly from patients, the approval committee exempted written informed consent from the participants. No personal information regarding patients was collected by the investigators, and each patient was given a study number, with all data subsequently kept confidential. The study concept and design were conceived by ZUM, MS, JCM, BG and RAS with subsequent input from all authors. ZUM, AS, MFM, MS, AN, THM, YHK, JCM, BG and RAS were involved with the acquisition of the data, reviewing data quality, verifying the data with different data sources, performing the statistical analyses, and developing the data visualizations. Funding acquisition: ZUM, BG, JCM, RAS. Preparation of first draft of the manuscript: ZUM, JCM, BG, and RAS. All authors edited and revised it critically for important intellectual content.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

COVID-19
hospitalization
intensive care units
Pakistan
fungal infections
mortality

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10.1016/j.ijregi.2024.100445Licence: CC BY-NC-ND 4.0

Mustafa-etal-IJIDR-2024-Predictors-and-outcomes-of-patients-with-COVID-19-admitted-to-intensiveFinal published version, 435 KBLicence: CC BY-NC-ND 4.0

Cite this

Ul Mustafa, Z., Suleman, A., Masood, M. F., Salman, M., Nazir, A., Malhi, T. H., Habib Khan, Y., Mudenda, S., Meyer, J. C., Godman, B., & Seaton, R. A. (2024). 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. IJID Regions, 13, Article 100445. https://doi.org/10.1016/j.ijregi.2024.100445

@article{acd95629f08944e091a47e3c5b6754c3,

title = "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",

abstract = "Objectives: Patients with COVID-19 admitted to intensive care units (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 to measure the prevalence rates, predictors of fungal infections, and outcomes of patients with COVID-19 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 in Pakistan between March 2020 and June 2023. Results: A total of 636 patients were included; 68.9\% were aged ≥50 years and 62.6\% were male. Diabetes mellitus was the commonest co-morbidity (23.7\%). A total of 67.8\% of patients had severe COVID-19, with 23\% critical cases. Antibiotics and antipyretics (all patients) were the most frequently prescribed medicines, along with corticosteroids (72.5\%). A total of 63 nosocomial fungal infections developed in 53 patients, with mechanical ventilation and tracheal intubation being significant predictors of secondary fungal infections among patients with COVID-19. The mortality rate was 4.9\%, with secondary fungal infections significantly associated with higher mortality. Conclusions: Approximately 8\% of patients with COVID-19 admitted to the ICUs of tertiary developed secondary fungal infections associated with greater mortality. The 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.",

keywords = "COVID-19, hospitalization, intensive care units, Pakistan, fungal infections, mortality",

author = "\{Ul Mustafa\}, Zia and Aneeqa Suleman and Masood, \{Muhammad Faiq\} and Muhammad Salman and Aftab Nazir and Malhi, \{Tauqeer Hussain\} and \{Habib Khan\}, Yusra and Steward Mudenda and Meyer, \{Johanna C.\} and Brian Godman and Seaton, \{R. Andrew\}",

year = "2024",

month = dec,

day = "31",

doi = "10.1016/j.ijregi.2024.100445",

language = "English",

volume = "13",

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Ul Mustafa, Z, Suleman, A, Masood, MF, Salman, M, Nazir, A, Malhi, TH, Habib Khan, Y, Mudenda, S, Meyer, JC, Godman, B & Seaton, RA 2024, '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', IJID Regions, vol. 13, 100445. https://doi.org/10.1016/j.ijregi.2024.100445

TY - JOUR

T1 - Predictors and outcomes of patients with COVID-19 admitted to Intensive Care Units in Pakistan and the development of nosocomial fungal infections

T2 - findings and implications

AU - Ul Mustafa, Zia

AU - Suleman, Aneeqa

AU - Masood, Muhammad Faiq

AU - Salman, Muhammad

AU - Nazir, Aftab

AU - Malhi, Tauqeer Hussain

AU - Habib Khan, Yusra

AU - Mudenda, Steward

AU - Meyer, Johanna C.

AU - Godman, Brian

AU - Seaton, R. Andrew

PY - 2024/12/31

Y1 - 2024/12/31

N2 - Objectives: Patients with COVID-19 admitted to intensive care units (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 to measure the prevalence rates, predictors of fungal infections, and outcomes of patients with COVID-19 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 in Pakistan between March 2020 and June 2023. Results: A total of 636 patients were included; 68.9% were aged ≥50 years and 62.6% were male. Diabetes mellitus was the commonest co-morbidity (23.7%). A total of 67.8% of patients had severe COVID-19, with 23% critical cases. Antibiotics and antipyretics (all patients) were the most frequently prescribed medicines, along with corticosteroids (72.5%). A total of 63 nosocomial fungal infections developed in 53 patients, with mechanical ventilation and tracheal intubation being significant predictors of secondary fungal infections among patients with COVID-19. The mortality rate was 4.9%, with secondary fungal infections significantly associated with higher mortality. Conclusions: Approximately 8% of patients with COVID-19 admitted to the ICUs of tertiary developed secondary fungal infections associated with greater mortality. The 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.

AB - Objectives: Patients with COVID-19 admitted to intensive care units (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 to measure the prevalence rates, predictors of fungal infections, and outcomes of patients with COVID-19 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 in Pakistan between March 2020 and June 2023. Results: A total of 636 patients were included; 68.9% were aged ≥50 years and 62.6% were male. Diabetes mellitus was the commonest co-morbidity (23.7%). A total of 67.8% of patients had severe COVID-19, with 23% critical cases. Antibiotics and antipyretics (all patients) were the most frequently prescribed medicines, along with corticosteroids (72.5%). A total of 63 nosocomial fungal infections developed in 53 patients, with mechanical ventilation and tracheal intubation being significant predictors of secondary fungal infections among patients with COVID-19. The mortality rate was 4.9%, with secondary fungal infections significantly associated with higher mortality. Conclusions: Approximately 8% of patients with COVID-19 admitted to the ICUs of tertiary developed secondary fungal infections associated with greater mortality. The 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.

KW - COVID-19

KW - hospitalization

KW - intensive care units

KW - Pakistan

KW - fungal infections

KW - mortality

UR - https://www.sciencedirect.com/journal/ijid-regions

U2 - 10.1016/j.ijregi.2024.100445

DO - 10.1016/j.ijregi.2024.100445

M3 - Article

SN - 2772-7076

VL - 13

JO - IJID Regions

JF - IJID Regions

M1 - 100445

ER -

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

Abstract

Funding

UN SDGs

Keywords

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