{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T22:15:18Z","timestamp":1777500918902,"version":"3.51.4"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T00:00:00Z","timestamp":1748563200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Microbiol."],"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To investigate the prognostic factors influencing the outcomes of children with invasive fungal infection in pediatric intensive care unit (PICU) and explore the effects of changes in clinical characteristics before and after the COVID-19 pandemic on treatment outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In total, 665 children with invasive fungal infections from the PICUs of four hospitals in China were retrospectively enrolled from January 2017 to December 2021. These children were categorized into an effective treatment group (336 cases) and a failure group (329 cases, including treatment abandonment and death) based on prognosis. Clinical data were compared between the pre-pandemic period (2017\u20132019, 421 cases) and the post-pandemic period (2020\u20132021, 244 cases). Univariate and multivariate logistic regression analyses were used to identify the factors related to prognosis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Prognostic factors: Independent risk factors for treatment failure included agranulocytosis (OR\u202f=\u202f3.389, 95% CI 1.518\u20136.287), hematological malignancies (OR\u202f=\u202f3.050, 95% CI 1.544\u20135.986), blood transfusion (OR\u202f=\u202f2.239, 95% CI 1.456\u20133.442), invasive mechanical ventilation (OR\u202f=\u202f1.938, 95% CI 1.158\u20133.243), and indwelling urinary catheter (OR\u202f=\u202f1.750, 95% CI 1.048\u20132.924). The independent protective factor was identified fungal pathogens (OR\u202f=\u202f0.588, 95% CI 0.362\u20130.956). Pre- and post-pandemic comparisons revealed that the co-infection rate decreased after pandemic (77.9% vs. 70.5%, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05), the proportion of identified fungal pathogens increased (60.6% vs. 68.0%, <jats:italic>p<\/jats:italic>\u202f=\u202f0.054), whereas, the treatment failure rate was significantly higher (45.8% vs. 55.7%, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05). Changes in fungal species after the pandemic: The proportions of <jats:italic>Candida<\/jats:italic> and <jats:italic>Aspergillus<\/jats:italic> had decreased (89.0% vs. 75.9%, <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05; 8.2% vs. 6.0%, <jats:italic>p<\/jats:italic>\u202f&amp;gt;\u202f0.05), whereas those of <jats:italic>Pneumocystis jirovecii<\/jats:italic> and other fungal species had increased significantly (0.4% vs. 7.8, 2.4% vs. 10.2%, all <jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Agranulocytosis, hematologic malignancies, invasive mechanical ventilation, indwelling urinary catheter and blood transfusion are independent risk factors for adverse outcomes with invasive fungal infections in PICU, and identifying the pathogen can improve outcomes. Post-pandemic changes in fungal species and cumulative risk factors may have offset the potential benefits of reduced co-infection rates, leading to increased treatment failure rates. Therefore, it is necessary to optimize invasive procedure management and provide early coverage for emerging pathogens in high-risk children.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmicb.2025.1605960","type":"journal-article","created":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T05:44:25Z","timestamp":1748583865000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Prognostic factors of invasive fungal infections in pediatric intensive care units and changes in treatment outcomes before and after the COVID-19 pandemic: a multicenter retrospective study"],"prefix":"10.3389","volume":"16","author":[{"given":"Yuhui","family":"Du","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Li","family":"Huang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiulan","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jun","family":"Su","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lidan","family":"Cui","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qunqun","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liming","family":"He","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tian","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ling","family":"Gong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guoping","family":"Lu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yibing","family":"Cheng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,5,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1007\/s12185-019-02776-x","article-title":"The D-index is not correlated with invasive fungal infection during the early-post engraftment phase among allogeneic hematopoietic stem cell transplant recipients","volume":"111","author":"Abad","year":"2020","journal-title":"Int. J. Hematol."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1071","DOI":"10.3390\/v14051071","article-title":"Collateral impact of public health and social measures on respiratory virus activity during the COVID-19 pandemic 2020\u20132021","volume":"14","author":"Achangwa","year":"2022","journal-title":"Viruses"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"717","DOI":"10.1016\/S2666-5247(24)00042-9","article-title":"The WHO fungal priority pathogens list: a crucial reappraisal to review the prioritisation","volume":"5","author":"Casalini","year":"2024","journal-title":"Lancet Microbe"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"22","DOI":"10.1111\/myc.12698","article-title":"Microbial epidemiology of candidaemia in neonatal and paediatric intensive care units at the Children's medical center, Tehran","volume":"61","author":"Charsizadeh","year":"2018","journal-title":"Mycoses"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1367","DOI":"10.1093\/cid\/ciz1008","article-title":"Revision and update of the consensus definitions of invasive fungal disease from the European Organization for Research and Treatment of Cancer and the mycoses study group education and research consortium","volume":"71","author":"Donnelly","year":"2020","journal-title":"Clin. Infect. Dis."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"234","DOI":"10.3969\/j.issn.1673-3827.2021.04.005","article-title":"Distribution characteristics of invasive yeast infections in the China hospital invasive fungal resistance surveillance net (CHIF-NET) in 2011","volume":"16","author":"Duan","year":"2021","journal-title":"Chin. J. Mycol."},{"key":"ref7","doi-asserted-by":"publisher","first-page":"252","DOI":"10.24953\/turkjped.2020.02.011","article-title":"Outcomes and prognostic factors for pediatric cancer patients admitted to an intensive care unit in a university hospital","volume":"62","author":"Dursun","year":"2020","journal-title":"Turk. J. Pediatr."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1097\/INF.0000000000003489","article-title":"Relationship between COVID-19 lockdown and epidemiology of neonatal sepsis","volume":"41","author":"Dutta","year":"2022","journal-title":"Pediatr. Infect. Dis. J."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e403","DOI":"10.1097\/MPH.0000000000000048","article-title":"Intensive care unit admission in children with malignant or nonmalignant disease: incidence, outcome, and prognostic factors: a single-center experience","volume":"36","author":"Faraci","year":"2014","journal-title":"J. Pediatr. Hematol. Oncol."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"180","DOI":"10.1016\/S2213-2600(21)00442-2","article-title":"Fungal infections in mechanically ventilated patients with COVID-19 during the first wave: the French multicentre MYCOVID study","volume":"10","author":"Gangneux","year":"2022","journal-title":"Lancet Respir. Med."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1097\/CCM.0000000000002867","article-title":"Initial antifungal strategy reduces mortality in critically ill patients with candidemia: a propensity score\u2013adjusted analysis of a multicenter study","volume":"46","author":"Garnacho-Montero","year":"2018","journal-title":"Crit. Care Med."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"10","DOI":"10.1128\/JCM.00354-18","article-title":"Microbial interactions in the cystic fibrosis airway","volume":"56","author":"Granchelli","year":"2018","journal-title":"J. Clin. Microbiol."},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2023-9-2","DOI":"10.7573\/dic.2023-9-2","article-title":"Invasive fungal infections in critically ill children: epidemiology, risk factors and antifungal drugs","volume":"13","author":"Hon","year":"2024","journal-title":"Drugs Context"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"e268","DOI":"10.1016\/S1473-3099(24)00102-6","article-title":"Global incidence and mortality of severe fungal disease","volume":"24","author":"Ikuta","year":"2024","journal-title":"Lancet Infect. Dis."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1223576","DOI":"10.3389\/fcimb.2023.1223576","article-title":"Diagnostic efficacy of metagenomic next generation sequencing in bronchoalveolar lavage fluid for proven invasive pulmonary aspergillosis","volume":"13","author":"Jia","year":"2023","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"868","DOI":"10.1093\/infdis\/jiab460","article-title":"Epidemiology and clinical impact of respiratory coinfections at diagnosis of pneumocystis jirovecii pneumonia","volume":"225","author":"L\u00e9cuyer","year":"2022","journal-title":"J. Infect. Dis."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"540","DOI":"10.2174\/1573396320666230811092915","article-title":"Invasive fungal infections in the paediatric intensive care unit: a Hong Kong study","volume":"20","author":"Li","year":"2024","journal-title":"Curr. Pediatr. Rev."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"645","DOI":"10.1007\/s15010-013-0432-0","article-title":"Epidemiology of invasive fungal infections in the intensive care unit: results of a multicenter Italian survey (AURORA project)","volume":"41","author":"Montagna","year":"2013","journal-title":"Infection"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"fmac106","DOI":"10.1093\/tropej\/fmac106","article-title":"Covid-period-associated changes in organism profile of neonatal sepsis in a tertiary center from East India","volume":"69","author":"Mukherjee","year":"2023","journal-title":"J. Trop. Pediatr."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1111\/myc.13225","article-title":"Increased incidence of candidemia in a tertiary care hospital with the COVID-19 pandemic","volume":"64","author":"Nucci","year":"2021","journal-title":"Mycoses"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1186\/s13054-016-1229-1","article-title":"Characteristics and risk factors for 28-day mortality of hospital acquired fungemias in ICUs: data from the EUROBACT study","volume":"20","author":"Paiva","year":"2016","journal-title":"Crit. Care"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"1732","DOI":"10.1007\/s00134-019-05789-6","article-title":"Invasive pulmonary aspergillosis in critically ill patients with hematological malignancies","volume":"45","author":"Pardo","year":"2019","journal-title":"Intensive Care Med."},{"key":"ref23","doi-asserted-by":"publisher","first-page":"320","DOI":"10.1186\/s13054-024-05104-w","article-title":"Relationship between SARS-CoV-2 infection and ICU-acquired candidemia in critically ill medical patients: a multicenter prospective cohort study","volume":"28","author":"Reizine","year":"2024","journal-title":"Crit. Care"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"395","DOI":"10.1016\/j.cnc.2021.07.002","article-title":"Invasive fungal infections among immunocompromised patients in critical care settings: infection prevention risk mitigation","volume":"33","author":"Riley","year":"2021","journal-title":"Crit. Care Nurs. Clin."},{"key":"ref25","author":"Rutala","year":"2008"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"2100746","DOI":"10.2807\/1560-7917.ES.2022.27.19.2100746","article-title":"Mycoplasma pneumoniae detections before and during the COVID-19 pandemic: results of a global survey, 2017 to 2021","volume":"27","author":"Sauteur","year":"2022","journal-title":"Eur. Secur."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"345","DOI":"10.1016\/j.chest.2021.08.081","article-title":"Risk factors for invasive Candida infection in critically ill patients: a systematic review and meta-analysis","volume":"161","author":"Thomas-R\u00fcddel","year":"2022","journal-title":"Chest"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"2323","DOI":"10.1001\/jama.2009.1754","article-title":"International study of the prevalence and outcomes of infection in intensive care units","volume":"302","author":"Vincent","year":"2009","journal-title":"JAMA"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"ofy187","DOI":"10.1093\/ofid\/ofy187","article-title":"Epidemiology and clinical features of invasive fungal infection in a US health care network","volume":"5","author":"Webb","year":"2018","journal-title":"Open Forum Infect. Dis."},{"key":"ref30","doi-asserted-by":"publisher","first-page":"701","DOI":"10.1016\/j.jmii.2020.06.007","article-title":"Identifying predictors for bacterial and fungal coinfection on chest computed tomography in patients with pneumocystis pneumonia","volume":"54","author":"Wu","year":"2021","journal-title":"J. Microbiol. Immunol. Infect."},{"key":"ref31","doi-asserted-by":"publisher","first-page":"577","DOI":"10.3760\/cma.j.issn.1673-4912.2016.09.001","article-title":"Current status of invasive fungal infection in pediatric intensive care unit","volume":"23","author":"Zhang","year":"2016","journal-title":"Chin. Pediatr. Emerg. Med."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"749905","DOI":"10.3389\/fcimb.2021.749905","article-title":"Prevalence of fungal and bacterial co-infection in pulmonary fungal infections: a metagenomic next generation sequencing-based study","volume":"11","author":"Zhao","year":"2021","journal-title":"Front. Cell. Infect. Microbiol."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"1142199","DOI":"10.3389\/fcimb.2023.1142199","article-title":"Epidemiological characteristics of respiratory viruses in hospitalized children during the COVID-19 pandemic in southwestern China","volume":"13","author":"Zhu","year":"2023","journal-title":"Front. Cell. Infect. Microbiol."}],"container-title":["Frontiers in Microbiology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2025.1605960\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,5,30]],"date-time":"2025-05-30T05:44:27Z","timestamp":1748583867000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmicb.2025.1605960\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,30]]},"references-count":33,"alternative-id":["10.3389\/fmicb.2025.1605960"],"URL":"https:\/\/doi.org\/10.3389\/fmicb.2025.1605960","relation":{},"ISSN":["1664-302X"],"issn-type":[{"value":"1664-302X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,30]]},"article-number":"1605960"}}