Desfechos clínicos da terapia antifúngica em pacientes críticos de acordo com o timing para início do tratamento baseado no número de fatores de risco para infecção por fungos

Abstract

Introduction: Fungal infections represent a significant public health challenge due to their potential personal impacts on patients and clinical complications that can lead to various comorbidities, along with the financial burden they impose on hospitals. Therefore, identifying and monitoring the various risk factors contributing to these infections is crucial for preventing their occurrence and, if already present, enabling early diagnosis to initiate prompt and effective treatment. Objective: This study aimed to evaluate the clinical outcomes associated with the initiation of antifungal therapy based on the number of risk factors present in each patient at the time of treatment initiation. Methods: A non-concurrent cohort study based on retrospective data was conducted at a public hospital in the interior of Bahia, Brazil, focusing on patients admitted to the Intensive Care Unit (ICU) from January 2014 to September 2015. All included patients received antifungal treatment during their ICU stay. Data were collected using structured questionnaires, and statistical analyses were performed using SPSS version 20.0.0. Results: Patients presenting with five or more risk factors at the time of antifungal therapy initiation had a 9.67 times higher risk of mortality compared to those with fewer risk factors. Furthermore, as the number of risk factors increased, both mortality rates and hospitalization durations significantly rose. Conclusion: This study highlighted that the presence of multiple risk factors in ICU patients is directly associated with unfavorable clinical outcomes, including higher mortality rates and prolonged hospital stays. Therefore, early identification and effective management of these risk factors are crucial for improving clinical outcomes and mitigating the impacts of fungal infections in hospital settings.