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

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 epidemiology, 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 antibiotics, 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.