Opportunistic Fungal Infections in Inflammatory Bowel Disease: Incidence, Risk Factors, and Outcomes From a Nationwide Analysis

Abstract BACKGROUND Inflammatory bowel disease (IBD) predisposes patients to infections due to immune dysregulation and frequent immunosuppressive therapy. Data on fungal infections in this population remain limited. We aimed to evaluate the prevalence, predictors, and outcomes of fungal infections in hospitalized patients with IBD using a nationally representative database. METHODS We conducted a retrospective cohort study utilizing the Nationwide Inpatient Sample (NIS) 2016–2020. Adult hospitalizations with IBD were identified using International Classification of Diseases, 10th Revision (ICD-10) codes. Fungal infections were defined using validated ICD-10 codes. Patient demographics, comorbidities, and hospital characteristics were compared between those with and without fungal infections. Multivariable logistic regression adjusted for confounders was used to evaluate associations with in-hospital outcomes. RESULTS Among 3, 203, 174 IBD-related hospitalizations, 23, 525 (1. 65%) had documented fungal infections. Patients with fungal infections were more likely to be female (67. 0% vs 56. 5%, p 0. 001), have higher comorbidity burden (Charlson index ≥3: 16. 5% vs 12. 5%, p 0. 001), and belong to lower median household income quartiles (p 0. 001). Compared with IBD patients without fungal infections, those with fungal infections had significantly higher in-hospital mortality (adjusted odds ratio aOR 0. 73, 95% CI 0. 58–0. 92, p = 0. 007), increased hospitalization costs (mean difference –9, 134, p = 0. 020), and greater need for mechanical ventilation (aOR 0. 58, 95% CI 0. 48–0. 71, p 0. 001). Rates of acute renal failure, dialysis, and septic shock trended higher but did not reach statistical significance after adjustment. CONCLUSION Fungal infections, though relatively uncommon in hospitalized patients with IBD, are associated with adverse clinical and economic outcomes, including higher mortality, greater resource utilization, and increased need for intensive care. Recognition of at-risk populations and early preventive or therapeutic strategies are warranted to mitigate these outcomes.