title: Risk factors for early invasive fungal disease in critically ill patients.
abstract: BACKGROUND
  The incidence of invasive fungal disease (IFD) is increasing worldwide in the past two to three decades. Critically ill patients in Intensive Care Units are more vulnerable to fungal infection. Early detection and treatment are important to decrease morbidity and mortality in critically ill patients.
  
  
  OBJECTIVE
  Our study aimed to assess factors associated with early IFD in critically ill patients.
  
  
  METHODS
  This prospective cohort study was conducted in critically ill patients, from March to September 2015. Total number of patients (74) in this study was drawn based on one of the risk factors (human immunodeficiency virus). Specimens were collected on day 5-7 of hospitalization. Multivariate analysis with logistic regression was performed for factors, withP< 0.25 in bivariate analysis.
  
  
  RESULTS
  Two hundred and six patients were enrolled in this study. Seventy-four patients were with IFD, majority were males (52.7%), mean age was 58 years (range 18-79), mean Leon's score was 3 (score range 2-5), majority group was nonsurgical/nontrauma (72.9%), and mean fungal isolation was positive on day 5.Candidasp. (92.2%) is the most frquently isolated fungal infection. Urine culture yielded the highest number of fungal isolates (70.1%). Mortality rate in this study was 50%. In multivariate analysis, diabetes mellitus (DM) (P= 0.018, odds ratio 2.078, 95% confidence interval 1.135-3.803) was found as an independent factor associated with early IFD critically ill patients.
  
  
  CONCLUSIONS
  DM is a significant factor for the incidence of early IFD in critically ill patients.
authors.affiliation: Department of Internal Medicine, Respirology and Critical Illness Division, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
authors.forename: Gurmeet
authors.initials: G
authors.lastname: Singh
authors.affiliation: Department of Internal Medicine, Respirology and Critical Illness Division, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
authors.forename: Ceva Wicaksono
authors.initials: CW
authors.lastname: Pitoyo
authors.affiliation: Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
authors.forename: Dita
authors.initials: D
authors.lastname: Aditianingsih
authors.affiliation: Department of Internal Medicine, Respirology and Critical Illness Division, Faculty of Medicine, Universitas Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
authors.forename: Cleopas Martin
authors.initials: CM
authors.lastname: Rumende
keywords: Candida; critically ill; diabetes mellitus; early invasive fungal disease; risk factor