A review on fungal surgical site infections: epidemiology, risk factors, main fungal agents, and prevention

Kiana  Shirani; Arash  Seifi; Alireza  Assadi; Ashkan  Mortazavi; SeyedAhmad  SeyedAlinaghi

doi:10.18502/ijm.v17i4.19225

Kiana Shirani Department of Infectious Diseases, Nosocomial Infection Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Arash Seifi Department of Infectious Diseases, Research Center for Antibiotic Stewardship and Antimicrobial Resistance, Tehran University of Medical Sciences, Tehran, Iran
Alireza Assadi Department of Infectious Diseases, Infectious Diseases and Tropical Medicine Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Ashkan Mortazavi Department of Infectious Diseases, Immunodeficiency Diseases Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
SeyedAhmad SeyedAlinaghi Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High-Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/ijm.v17i4.19225

Keywords: Surgical wound infection; Mycoses; Candidiasis; Aspergillosis; Mucormycosis; Postoperative complications; Antifungal agents; Risk factors; Immunocompromised host; Infection control

Abstract

Fungal surgical site infections (SSIs) may be less common than bacterial SSIs but are a significant clinical issue due to their challenging diagnosis, higher morbidity, and rising incidence, particularly in immunocompromised patients. The epi- demiology, risk factors, prevalent fungal pathogens, and prevention of SSIs caused by fungi are discussed in this narrative review. Systematic literature search for the period 2000 to 2024 was conducted on top databases using relevant MeSH keywords. The most frequent solitary pathogens were Candida spp., followed by Aspergillus and Mucor spp., especially in transplant, cardiac, and GI infections. The greatest challenge is extended length of hospital stay, broad-spectrum anti- biotics, immunosuppression, and invasive interventions with prosthetic device or shunts. While it creates added burden, fungal SSIs go unnoticed by clinical practice and are rarely included in SSI prevention strategies. The review declares the significance of enhanced clinical vigilance and tailored antifungal prophylaxis in high-risk exposure surgical procedures. The review, based on the integration of existing information, provides clinicians and infection control practitioners with a framework of fungal SSIs so that they can be better equipped to assess risk, detect infection sooner, and focus prevention efforts.