Impact of a Multifaceted Prevention Strategy on Invasive Fungal Infections in a Surgical Pediatric Cardiac ICU

Invasive fungal infections were rare but serious complication in pediatric patients following cardiac surgery. Data on the epidemiology, clinical characteristics, and preventive strategies remain limited.

This was a retrospective before-after study. We reviewed a prospectively maintained database in our pediatric cardiac ICU between 2018 and 2024. All patients who developed invasive fungal infections following cardiac surgery were included. Since our center began the invasive fungal infections prevention bundle in 2021, patients from 2018 to 2020 were included in pre-bundle group, patients from 2021 to 2024 were included in post-bundle group. Our fungal prevention bundle included: 1) Actively providing prophylactic antifungal drugs based on risk stratification. 2) Enhancing hospital acquired infection management. 3) Multi-disciplinary treatment, clinical pharmacists participate in antimicrobial stewardship. 4) Establishing an ICU infection control team to ensure the implementation of the above measures.

In this cohort of 19,761 postoperative pediatric patients, 38 cases (0.19%) of invasive fungal infections were identified, all manifesting as fungal sepsis. Clinical manifestations of infection included fever, an increased leukocyte count, neutrophil percentage, (1,3)-β-D-glucan, C-reactive protein and procalcitonin value. Fourteen patients (37%) exhibited circulatory instability. The median time from surgery to infection was 23 (8, 56) days, with a mortality rate of 24%. Comparative analysis between study periods revealed improvements in infection control measures. Hand hygiene compliance increased from 48% to 61% (P < 0.001), antibiotic consumption (defined daily dose) reduced from 32.7 to 27.5 (P < 0.001). Following group stratification, the incidence of invasive fungal infections was lower in post-bundle group (0.11%; 12/11,194) than in pre-bundle group (0.3%; 26/8567), P = 0.002.

Based on the study findings, the implementation of a multifaceted fungal prevention bundle was associated with a significant reduction in the incidence of invasive fungal infections in pediatric patients after cardiac surgery.