# 399. High Burden of Invasive Fungal Infections in Critical Care Units of Bangladesh: Findings from Ongoing sentinel Surveillance

## TL;DR

This study finds a high rate of invasive fungal infections in Bangladeshi critical care units, with emerging resistant pathogens like Candida auris and Candida blankii.

## Contribution

The study provides the first detailed assessment of invasive fungal infection burden and antifungal resistance in critical care units in Bangladesh.

## Key findings

- 35% of enrolled patients had fungal-positive blood cultures, with NICUs showing the highest burden at 60%.
- Candida blankii and Kodamaea ohmeri were predominant in NICUs, while Candida auris and Candida tropicalis were common in adult ICUs.
- High azole resistance was observed in Candida auris and Candida blankii, correlating with increased mortality.

## Abstract

Invasive fungal infections (IFIs) are associated with severe complications and high mortality, particularly in critically ill patients. Despite their clinical significance, the true burden of IFIs remains poorly understood in low- and middle-income countries (LMICs) like Bangladesh, primarily due to the lack of structured surveillance systems. This study aims to assess the burden of IFIs among patients admitted to critical care units in Bangladesh.Circulating fungal pathogens among neonatesMIC values of different antifungal for Candida auris and Candida blankii isolates

Circulating fungal pathogens among neonates

MIC values of different antifungal for Candida auris and Candida blankii isolates

Since August 2022, hospital-based sentinel surveillance has been ongoing in the ICU, NICU, and PICU of two tertiary-level hospitals in Dhaka. By March 2025, a total of 829 patients with suspected IFIs were enrolled based on predefined criteria. Blood and endotracheal aspirate samples were processed using microscopy, culture, and identification via Vitek 2 and Vitek MS systems. Antifungal susceptibility testing (AFST) was performed using E-test methods for selected isolates.

Overall, 35% of the enrolled patients had fungal-positive blood cultures, though positivity varied by unit. Adult ICUs showed 7.5% positivity (n=351), with Candida auris and Candida tropicalis (6 each) being predominant. PICUs demonstrated 31% positivity (n=123), mostly infected with Candida blankii (18). NICUs revealed the highest burden (60%, n=355), with C. blankii (107) and Kodamaea ohmeri (61) as predominant species. Empirical antifungal use, particularly fluconazole and voriconazole, was common (26%); however, high azole resistance was noted, especially in C. auris and C. blankii and was associated with higher mortality.

There is significant IFI burden in critical care units of Bangladesh with frequent identification of emerging and resistant pathogens. These findings highlight the urgent need for affordable diagnostics, standardized AFST protocols, and incorporation of IFI-specific strategies into antimicrobial stewardship programs to ensure rational anti-fungal use and curb resistance.

All Authors: No reported disclosures