The patterns of antifungal use and risk factors associated with mortality in patients with invasive candidiasis and aspergillosis infections among patients who were received infectious disease specialist consultation prior to and during the COVID-19 pandemic in a resource-limited setting: A retrospective cohort study

Background: Limited data is available concerning the patterns of antifungal use and Invasive fungal infection (IFI)-associated mortality risk factors in patients with IFI prior to and during the Coronavirus disease 2019 (COVID-19) pandemic in resource-limited settings. Methods: A single-center retrospective cohort study was conducted. All patients age >18 years diagnosed with IFIs were prospectively followed during a 3-year pre-COVID-19 pandemic period and a 3-year during COVID-19 pandemic period. Patient characteristics, the patterns of antifungal use, IFI-associated mortality risk factors, and adverse drug events were collected. Results: There was a total of 133 patients in this study: 60 (45.1%) were in period 1 and 73 (54.9%) were in period 2. Pre-emptive antifungal therapy was commonly practiced in period 2 (21.7% vs 37%, P = .05). The presence of a central venous catheter (aOR 3.19, P = .007), hematologic adverse drug events (aOR 17.9, P = .008) were preventable risks for the overall IFI mortality in both periods. Appropriate antifungal use was protective against the overall IFI mortality in period 2 (aOR 0.09, P = .009). Conclusions: Several preventable risk factors associated with mortality were identified and served as a key for improvement of infection prevention, national policy to access antifungal agents, and antifungal stewardship in resource-limited settings.