Fungal Sepsis in the ICU: Etiology and Susceptibility Profile to Antifungals in Lubumbashi, Democratic Republic of the Congo

Background: Fungal sepsis is a major cause of mortality in intensive care units (ICUs), particularly in resource-limited countries where access to diagnostics and antifungal treatments is restricted. In the Democratic Republic of the Congo (DRC), data on these infections remain scarce. This study aims to identify the fungal pathogens responsible for sepsis in ICUs and evaluate their antifungal susceptibility profiles. Methods: This was a prospective multicenter study conducted between 2022 and 2023 in three hospitals in Lubumbashi. ICU patients suspected of fungal sepsis were included. Biological samples were analyzed for fungal identification and antifungal susceptibility testing. Clinical and demographic data, including comorbidities and infection entry sites, were collected and analyzed using SPSS and Excel software. Results: Among 33 patients, the mean age was 49.14 ± 22.29 years, with a male predominance (57.6%). The most common comorbidities were hypertension (24%) and diabetes (15.5%). The primary infection entry sites were the genitourinary tract (67%), lungs (60%), and multiple-site infections (58%). The most frequently isolated fungal species were Candida albicans (50.17%), followed by non-albicans Candida species (45.3%) and Aspergillus spp. (4.51%). Antifungal susceptibility testing revealed a high resistance of non-albicans Candida to fluconazole (77.8%), whereas C. albicans remained susceptible to amphotericin B (86.4%), nystatin (77.3%), and caspofungin (63.6%). The overall mortality rate was 71.43%, with 75% of deaths occurring within the first five days and more than 80% after ten days of hospitalization. Conclusion: Fungal infections in ICUs in Lubumbashi are predominantly caused by Candida albicans, with significant antifungal resistance observed in non-albicans Candida species and a high mortality rate. Optimized management, including early diagnosis, rigorous microbiological surveillance, and improved antifungal stewardship, is crucial to improving patient outcomes in intensive care.