Search Results (5,911)

Background/Objectives: Mechanical ventilation (MV) is a crucial intervention in managing severe respiratory failure due to COVID-19. However, its use may be complicated by pulmonary barotrauma, a serious event associated with increased morbidity and mortality. Understanding its incidence and associated risk factors is essential for optimising ventilatory strategies and improving patient outcomes. The aim of this study was to determine the incidence and risk factors associated with the development of pulmonary barotrauma in mechanically ventilated patients with COVID-19. Methods: All mechanically ventilated patients aged 18 years and above who were admitted to the COVID-19 Intensive Care Unit (ICU) from January 2021 to June 2022 were included. Patients who developed pulmonary barotrauma prior to or within 24 h of ICU admission, had iatrogenic pneumothorax, were readmitted to the ICU, or were ventilated for causes other than COVID-19-related respiratory failure were excluded. Data on patient demographics, vaccination status, ventilator parameters, laboratory findings, and the use of steroid or immunomodulatory therapies were collected and analysed. Univariate and multivariate logistic regression analyses were performed to identify the potential risk factors and clinical outcomes associated with pulmonary barotrauma. Results: The medical records of 204 patients were included. The incidence of pulmonary barotrauma was 22.5%. Lower C-reactive protein (CRP) levels at ICU admission, lower FiO₂ requirements during the first week of MV, a higher positive end-expiratory pressure (PEEP) during the second week, and a prolonged mechanical ventilation duration were significantly associated with pulmonary barotrauma (p = 0.039, 0.049, 0.021, and 0.036, respectively). Patients who developed pulmonary barotrauma experienced longer ICU stays (p = 0.006) and higher all-cause ICU mortality (p = 0.009). Conclusions: Lower CRP levels and a lower FiO₂ requirements, a higher PEEP use, and longer ventilator days were the independent risk factors for pulmonary barotrauma in our study population, leading to a longer ICU stay and higher all-cause ICU mortality. Full article

Background/Objectives: Hospitalisations in systemic lupus erythematosus (SLE) reflect disease severity, accumulated damage, and the burden of comorbidity, remaining a major determinant of healthcare utilisation. Recent evidence suggests a shift from flare-driven admissions toward complications related to infections, comorbidities, and long-term treatment effects. We aimed to analyse the causes, characteristics, and outcomes of hospital admissions in patients with systemic lupus erythematosus (SLE) over a 30-year period in a tertiary referral centre in Catalonia (Spain) and to evaluate changes over time and prognostic factors associated with adverse outcomes. Methods: A retrospective observational study was conducted including all SLE patients admitted to the Department of Autoimmune Diseases at Hospital Clínic de Barcelona between June 1995 and December 2024. Admissions lasting less than 48 h or lacking clinical documentation were excluded. Variables analysed included demographics, disease duration, comorbidities, cause of admission, treatments, and outcomes. A composite outcome was defined as intensive care unit (ICU) admission, 30-day readmission, or prolonged hospital stay. Statistical analyses included univariate and multivariate regression models. Results: Among the 1216 hospital admissions, SLE flares and infections were the most frequent causes. Over the study period, admissions due to infections increased significantly and, in the last five years, exceeded those related to disease flares (33.7% vs. 26.1%). Patients hospitalized for flares were younger and had a shorter disease duration, whereas infection-related admissions were more common among older patients, those with overlap syndromes, and those with higher damage scores. Vascular events and SLE flares were independently associated with poorer outcomes. Although antimalarial use increased over time, it remained suboptimal, largely due to drug toxicity and newly diagnosed cases (from 45.2% to 69.7%; p < 0.001). Treatment strategies also evolved, with a shift toward lower glucocorticoid doses (from 14.5% to 38.3%; p < 0.001), and mycophenolate mofetil replacing cyclophosphamide as the preferred immunosuppressive agent. Conclusions: Hospitalisation patterns in SLE have shifted over time, with infections emerging as the leading cause of admission. This trend reflects an evolving patient profile characterized by older age, greater accumulated damage, comorbidities, and increased exposure to immunosuppressive therapies. These findings underscore the need for optimized infection prevention strategies and individualized treatment approaches to improve outcomes in contemporary SLE care. Full article

Background: Antifungal resistance among Candida species represents a growing clinical challenge, particularly in the context of increasing prevalence of non-albicans species. Methods: We conducted a retrospective analysis of 747 fungal isolates collected between 2021 and 2026, evaluating species distribution, antifungal susceptibility profiles, minimum inhibitory concentration (MIC) patterns, and temporal trends in resistance. Results: Non-albicans Candida species accounted for 67.5% of isolates, exceeding the proportion of Candida albicans. Fluconazole and flucytosine exhibited the highest resistance rates (16.1% and 17.4%, respectively), while amphotericin B showed the highest susceptibility rate (82.1%). MIC analysis revealed elevated MIC90 values for azoles in Candida glabrata and Candida krusei, consistent with reduced susceptibility. A significant association between antifungal agent and susceptibility profile was observed (χ² = 33.81, p < 0.001; Cramér’s V = 0.205). Temporal analysis demonstrated fluctuating resistance patterns rather than a consistent increase over time. Multidrug resistance was uncommon (2.5%), although non-susceptibility to multiple agents was more frequent (20.3%). Conclusions: The study highlights substantial variability in antifungal susceptibility across Candida species and antifungal agents, emphasizing the importance of continuous surveillance and species-specific treatment strategies. Full article

Objective: This study aimed to identify clinically modifiable and readily accessible predictors of 30-day mortality in a 10-year candidemia cohort and to assess temporal changes in Candida species distribution. Methods: We retrospectively evaluated 391 hospitalized adults with positive blood cultures for Candida spp. between January 2015 and March 2025. Only the first candidemia episode was included. Demographic characteristics, comorbidities, risk factors, laboratory parameters, antifungal therapy, and outcomes were recorded. Species identification was performed using conventional methods and the VITEK 2 system. Factors associated with 30-day mortality were analyzed using univariate and multivariate logistic regression models. Results: The mean age was 64.5 ± 17.7 years, and 56.3% of patients were male. Most patients (68.8%) were managed in the intensive care unit, and the 30-day mortality rate was 54%. Non-albicans Candida species accounted for 62.7% of isolates, with an increasing trend over time, particularly for Candida glabrata. Fluconazole susceptibility was 79%. In univariate analysis, advanced age, solid tumors, invasive mechanical ventilation, leukocytosis, thrombocytopenia, septic shock, intensive care unit admission, and failure to remove the central venous catheter were associated with mortality. Multivariate analysis identified advanced age, intensive care unit admission, septic shock, failure to remove the central venous catheter, leukocytosis, and thrombocytopenia as independent predictors of 30-day mortality. Conclusions: Candidemia remains a life-threatening infection with high mortality. Central venous catheter management and simple hematological parameters, particularly white blood cell and platelet counts, provide practical tools for early risk stratification. Although the rising prevalence of non-albicans Candida species may require updates in empirical therapy, prompt source control remains essential to improve survival. Full article

Background: Tranexamic acid (TXA) is an antifibrinolytic agent that helps prevent and manage bleeding events. In patients with trauma, TXA reduced bleeding-related deaths by one-third. Moreover, TXA showed a lower risk of mortality from bleeding in postpartum patients. Few studies have examined the appropriateness of TXA use for the management of bleeding in critically ill patients. This study aimed to describe the clinical outcomes and the safety of TXA use in critically ill patients with bleeding. Methods: This single-center, single-arm descriptive study was conducted at King Faisal Specialist Hospital & Research Center, Jeddah, between January 2018 and March 2023. The study included adult patients 18 years or older who were admitted to the medical intensive care unit (ICU) for ≥48 h and had documented bleeding that was treated with TXA for at least one dose. The primary outcome was the frequency of thrombotic events. Secondary outcomes included time from bleeding onset to bleeding resolution, rebleeding event at 30 days, time from bleeding onset to rebleeding event, ICU and hospital length of stay, and 30-day all-cause mortality. Results: A total of 129 patients were included in the study, 55% of whom were male. The median age was 60.9 years. The median APACHE II score was 22 (15–29). At baseline, 24.8% of patients had a history of bleeding. Major bleeding occurred in 86.1% of the patients. The frequency of thrombotic events was 2.3%. The median bleeding duration was 3.9 days (1.9–7.0). Rebleeding events at 30 days occurred in 24.8% of patients, with a median time of 11.7 days (8–14.8) from bleeding onset to rebleeding. The average ICU length was 12 days (6–24), and the average hospital length of stay was 25 days (15–50). The 30-day all-cause mortality rate was 55.8%. Multivariable analysis assessing factors contributing to mortality revealed that higher APACHE II score was strongly associated with increased mortality (adjusted OR 1.14 per point increase, 95% CI 1.07–1.21, p < 0.001), while higher platelet counts were independently protective, with each 10 × 10⁹/L increase associated with a 4% reduction in mortality odds (adjusted OR 0.96, 95% CI 0.93–0.99, p = 0.034). Conclusions: In this descriptive study, TXA use in critically ill patients was accompanied by low absolute rates of thrombotic and rebleeding events. Further studies with larger sample sizes and comparable groups are needed to examine the appropriateness of TXA use in managing bleeding events in the ICU. Full article

Background/Objectives: Preterm infants are particularly vulnerable to nutritional deficiencies and electrolyte imbalances during the early stages of extrauterine life. To ensure optimal metabolic support, they often require the early initiation of “aggressive” parenteral nutrition (PN), which is a known risk factor for Refeeding Syndrome (RS), a potentially serious metabolic condition characterized by fluid and electrolyte disturbances, the most significant of which is hypophosphatemia. Hypophosphatemia can impair the metabolism, survival, and function of red blood cells, leading to a reduction in key intracellular metabolites and the development of a metabolic block that alters their quality and decreases their stability. It is therefore hypothesized that RS may contribute to the development of anemia of prematurity (AOP). At the same time, early enteral nutrition (EN) may promote metabolic adaptation and reduce exposure to the complications of prolonged parenteral support, potentially protecting against AOP. The primary aim of this study was to determine whether preterm infants who develop RS are at increased risk of AOP. A secondary aim was to evaluate whether early EN may act as a protective factor against the development of AOP. Methods: This retrospective observational study was conducted on infants with a gestational age ≤ 34 weeks and/or birth weight ≤ 1500 g, admitted to the Neonatal Intensive Care Unit of Policlinico Umberto I—Sapienza University of Rome, between January 2015 and November 2022. Infants diagnosed with AOP were classified as cases, while those without AOP served as the control group. Results: A total of 412 preterm infants were enrolled (110 cases, 302 controls). Refeeding Syndrome was significantly more frequent in infants with AOP (30.9% vs. 11.6%, p < 0.001). In the logistic regression model adjusted for gestational age, RS was independently associated with AOP (OR = 2.81; 95% CI: 1.55–5.10; p < 0.001), along with gestational age ≤ 34 weeks (OR = 7.10; 95% CI: 2.13–24.0; p = 0.001). Early enteral nutrition during the first week of life was associated with a significantly lower risk of AOP (OR = 0.12; 95% CI: 0.029–0.52; p = 0.005). The association between RS and AOP was confirmed in the model adjusted for birth weight (OR = 2.06; 95% CI: 1.16–3.79; p = 0.021). Infants with AOP showed significantly higher parenteral nutrition intake, delayed initiation of enteral feeding, and later achievement of full enteral nutrition compared with controls (all p < 0.001). Conclusions: RS is significantly associated with AOP in preterm infants, likely through pathophysiological mechanisms related to hypophosphatemia. Importantly, early EN may be a protective factor against AOP, suggesting that timely initiation and advancement in enteral feeding may counteract the metabolic derangements associated with intensive parenteral support. These findings support a nutritional approach that prioritizes early and progressive enteral nutrition as a strategy to reduce the risk of both RS and AOP. Further prospective studies are needed to confirm these associations and to define optimal EN protocols for this population. Full article

Objectives: The aim of this study is to investigate the relationship between the lactate/albumin ratio (LAR) and 28-day mortality in gastric cancer patients undergoing monitoring in a postoperative intensive care unit due to reasons such as haemodynamic instability, need for vasopressor support, or intraoperative bleeding. Methods: This retrospective study included patients followed up at the tertiary surgical intensive care unit of Kastamonu University Faculty of Medicine between January 2020 and October 2025 who were diagnosed with histologically confirmed gastric adenocarcinoma and underwent total open surgery or subtotal gastrectomy + D2 lymphadenectomy. The patients were categorized into two groups: non-survivors within 28 days (n: 45) and survivors within 28 days (n: 139). Results: A total of 184 critically ill patients (110 males, 74 females) who underwent gastric adenocarcinoma surgery and were followed up in the surgical intensive care unit were included in this study. The mean age of the patients was 72.2 ± 11.3 years. Of these patients, 139 (75.5%) were survivors, and 45 (24.5%) were non-survivors. Albumin, the C-reactive protein (CRP)/albumin ratio, lactate, and the lactate/albumin ratio were associated with 28-day mortality. Receiver operating characteristic (ROC) analysis showed that the LAR (area under the curve (AUC): 0.839) was superior to the serum albumin (AUC: 0.736) and lactate levels (AUC: 0.796) for predicting 28-day mortality. The optimal cut-off value of the LAR was 0.82, and an LAR of ≥ 0.82 was shown to be a significant and independent prognostic factor for 28-day mortality in patients with stomach cancer in a critical postoperative condition (odds ratio (OR): 4.78, confidence interval (CI): 1.09–21.08, p = 0.0386). Conclusions: The lactate/albumin ratio is a prognostic parameter for 28-day mortality in critically ill postoperative gastric cancer patients. The optimal cut-off value for the lactate/albumin ratio is 0.82. Full article

Background: The ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (PaO₂/FiO₂) is central to the classification of acute respiratory distress syndrome (ARDS). However, its assessment requires arterial blood gas analysis, which may be limited by availability, cost, and invasiveness. Consequently, the ratio of peripheral oxygen saturation to fraction of inspired oxygen (SpO₂/FiO₂) has been proposed as a non-invasive surrogate for estimating the degree of oxygenation impairment. Methods: A retrospective cross-sectional study was conducted in adult patients with COVID-19 admitted to the intensive care unit at an altitude of 2600 m above sea level (m.a.s.l.). Spearman correlation coefficients were calculated to assess the association between the SpO₂/FiO₂ and PaO₂/FiO₂ ratios and their corresponding imputation models. A generalized linear model was applied, and the diagnostic performance of the SpO₂/FiO₂ ratio and the imputation models for detecting severe and non-severe hypoxemia (PaO₂/FiO₂ cutoff value of 150) was evaluated using the area under the receiver operating characteristic curve (AUC). Results: A total of 473 patients receiving invasive mechanical ventilation were included, with a mean age of 62.4 years (SD 14.1), and a predominance of males (67.2%). An SpO₂/FiO₂ ratio cutoff value of ≥206 demonstrated excellent diagnostic performance, with an AUC of 0.983 (95% CI 0.97–0.99), high sensitivity (90.6%), high specificity (96.7%), and an overall correct classification rate of 93.9%. This performance remained consistent across multiple clinical scenarios. In patients with positive end-expiratory pressure > 10 cmH₂O, the AUC was 0.982, with a specificity of 97.7%. In the presence of hyperbilirubinemia (total bilirubin ≥ 3 mg/dL), the AUC was 0.951. Among patients with hemoglobin levels < 10 g/dL, sensitivity reached 100%, although specificity was reduced. In the subgroup with arterial partial pressure of carbon dioxide > 35 mmHg, an SpO₂/FiO₂ ratio ≥ 206 showed near-perfect specificity (99.4%) and a positive likelihood ratio of 120.9. Conclusions: The SpO₂/FiO₂ ratio is a reliable and non-invasive surrogate of the PaO₂/FiO₂ ratio in mechanically ventilated patients with COVID-19 living at high altitude, particularly for the identification of non-severe hypoxemia. Full article

Neonatal infections remain a leading cause of morbidity and mortality worldwide, particularly among preterm and low-birth-weight infants and in low- and middle-income countries. This burden has intensified with the global increase in multidrug-resistant (MDR) bacteria, especially in neonatal intensive care units, where prolonged hospitalization, invasive interventions, and exposure to broad-spectrum antibiotics promote colonization, transmission, and invasive infection. In this narrative review, we explore the epidemiology and microbiological characteristics of MDR bacterial infections in newborns, alongside their associated risk factors, diagnostic challenges, treatment outcomes, and prevention strategies. Across different settings, Gram-negative pathogens, particularly Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii, account for a substantial proportion of severe neonatal infections, whereas methicillin-resistant Staphylococcus aureus remains important in selected units. The risk of MDR infection is driven by a complex interplay of factors, ranging from maternal and perinatal exposures to the inherent immunological vulnerability of newborns, hospital-based transmission, antibiotic selection pressure, and structural deficiencies in healthcare infrastructure. Diagnosis remains challenging because clinical presentations are nonspecific and culture-based methods are constrained by low blood volumes, prior antimicrobial exposure, and delayed turnaround times. Treatment is increasingly complicated due to resistance to standard empirical regimens, substantial regional variation in susceptibility profiles, and limited neonatal pharmacokinetic and safety data for reserve agents. Current evidence mainly supports surveillance-informed empirical therapy, susceptibility-guided treatment adjustment, antimicrobial stewardship, and strict infection prevention measures. Future progress will require neonatal-specific clinical trials, harmonized surveillance systems, stronger molecular epidemiology, and more equitable access to microbiological diagnostics and effective treatment. Full article

Background/Objectives: Sepsis is defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. Identifying reliable biomarkers that reflect the underlying immune pathophysiology of sepsis and support early risk stratification remains a major clinical priority. This prospective study aimed to evaluate the prognostic value of interleukin-6 (IL-6) measured at ICU admission in patients with sepsis and septic shock. Methods: This prospective observational study included adult patients with sepsis and septic shock admitted to the Intensive Care Unit (ICU) of the Clinical Hospital of Infectious Diseases Constanța between 2021 and 2025. Receiver operating characteristic (ROC) curve analysis with DeLong comparisons, Kaplan–Meier survival analysis, and Cox proportional hazards regression modeling were performed to assess the association between baseline IL-6 levels, in-hospital mortality, and time to death. Results: Among the analyzed biomarkers, IL-6 demonstrated the highest discriminatory performance for in-hospital mortality (AUC = 0.956; 95% CI: 0.893–0.987; p < 0.0001). The optimal cut-off value (>135.14 pg/mL) yielded a sensitivity of 87.65% and specificity of 92.86% (Youden index = 0.805). However, despite this excellent discrimination between survivors and non-survivors, baseline IL-6 levels were not significantly associated with time-to-death in Cox proportional hazards regression analysis. Conclusions: Admission IL-6 showed excellent discriminatory performance for mortality risk stratification but was not associated with survival duration in time-to-event analyses. These findings suggest that IL-6 should be interpreted primarily as an early risk stratification biomarker rather than a predictor of survival duration in patients with sepsis. Full article

Background/Objectives: The coronavirus disease 2019 (COVID-19) pandemic presented significant psychosocial challenges to intensive care unit health care workers (ICU HCW). Prior studies typically used single cross-sectional samples to focus on elements of burnout and psychological stress. We sought to serially assess quality of life and willingness to work before, during, and after the first peak of COVID-19. Methods: Two survey instruments were prospectively administered at regular intervals to multidisciplinary ICU HCWs, initiating at the local onset of COVID-19 and ending 6 months after the first peak ICU census of COVID-19 patients. Results: ICU HCWs reported high levels of compassion satisfaction, burnout, and secondary traumatic stress before, during and after the first peak of COVID-19. Motivation to work declined, and hesitation to work increased from study initiation to the peak ICU census of COVID-19 patients. Hesitation to work was greater in female HCWs and cardiothoracic ICU HCWs. Motivation to work was higher in those working in operating rooms compared to those in the ICU. Concerns about becoming infected, feelings of isolation, and exhaustion were associated with high hesitation to work. Feeling protected by the government and hospital was associated with decreased hesitation and increased motivation to work. Conclusions: ICU HCWs experienced high levels of stress throughout the first year of COVID-19, while satisfaction with work remained high. Willingness to work was associated with gender, work location, ICU subtype, concerns about infection risk, feelings of exhaustion, and feelings of institutional protection. Because the study methodology precludes causal inference and low survey response rates indicate that findings should be interpreted with caution, these results are best viewed as hypothesis-generating for future work aimed at improving stress mitigation in ICU HCWs. Full article

Calcium channel blockers (CCBs) are frequently used in the emergency department and intensive care unit for a wide range of critical conditions, including atrial fibrillation, hypertensive emergencies, acute pulmonary edema with sympathetic crashing, pulmonary hypertension, and vasospastic syndromes. However, their toxicity can lead to significant hemodynamic compromise, underscoring the importance of understanding their pharmacologic effects and safety profile. This review summarizes the current applications of CCBs in critically ill patients, evaluates their safety in congestive heart failure, and highlights emerging therapeutic roles and recent advances in the management of CCB toxicity. Full article

Objective: This study evaluated the relationships between the development and clinical course of pressure injuries (PIs) and neurological status, nutritional risk, and laboratory parameters among patients admitted to a tertiary intensive care unit. Materials and Methods: The single-center, retrospective, observational study included 220 patients hospitalized in the intensive care unit for at least 5 days. On the day of admission, Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation II (APACHE II), Braden, and Nutritional Risk Screening 2002 (NRS-2002) scores were assessed. Demographic characteristics, comorbidities, need for sedation and vasopressors, and laboratory parameters during the first 24 h (albumin, C-reactive protein, lactate, D-dimer) were analyzed. Factors independently associated with new PI development and clinical improvement were identified using binary logistic regression. Results: New PIs developed in 25% of patients. Patients with PI progression were older and had lower GCS and Braden scores, higher NRS-2002 scores, lower albumin levels, and higher D-dimer levels (p < 0.05). In multivariable analysis, low GCS (OR = 0.824), presence of comorbidity (OR = 2.327), and a high NRS-2002 risk level were independent predictors of new PI development. The model’s discriminative ability was acceptable (AUC = 0.756). Among patients with existing PIs, NRS-2002 score (OR = 0.450) and age (OR = 1.058) were independently associated with clinical improvement in an exploratory multivariable model. Conclusions: NRS-2002 was the only variable independently associated with both new PI development and the clinical improvement of existing lesions, underscoring the central role of nutritional risk assessment in ICU-based PI prevention and prognosis. Full article

Background/Objectives: Fenestrated and branched endovascular aortic repair (F/BEVAR) is increasingly used for the treatment of complex aortic aneurysms, and is traditionally performed under general anesthesia (GA). Data on the use of local anesthesia (LA) for F/BEVAR remain limited. This study aimed to report early outcomes of F/BEVAR performed under LA versus GA, with a focus on feasibility and perioperative complications in a high-risk patient population. Methods: This single-center retrospective analysis included patients undergoing F/BEVAR under LA or GA. Primary outcomes were in-hospital mortality and in-hospital complications. Secondary outcomes included early reintervention, intensive care unit and hospital length of stay, blood transfusion requirements, and technical success. Results: A total of 359 patients were included, of whom 25 (7.0%) were treated under LA and 334 (93.0%) under GA. Conversion from LA to GA occurred in 6 patients (24%). Patients in the LA group represented a higher-risk cohort, with advanced age, higher ASA class, larger aneurysm diameters, and a greater proportion of emergency and ruptured repairs. Technical success was high, and procedural metrics were within expected ranges. In-hospital mortality was numerically higher in the LA group (12.0% vs. 2.9%, p = 0.05). Overall, in-hospital complications were more frequent in the LA group (68.0% vs. 41.3%, p = 0.009), including a higher rate of spinal cord ischemia (24.0% vs. 8.5%, p = 0.02). Blood transfusion requirements were also greater in patients treated under LA (p = 0.004), while blood loss, ICU stay, and hospital length of stay were comparable. Early reintervention occurred more frequently in the LA group (31.8% vs. 10.4%, p = 0.009). Conclusions: LA appears feasible in selected high-risk patients undergoing complex F/BEVAR. However, given substantial baseline differences between groups, no conclusions can be drawn regarding comparative safety or efficacy relative to GA. These findings should be considered preliminary. Full article

Background and Objectives: The epidemiological characteristics of Candida species have changed worldwide, with an increasing number of reports on co-infections with non-albicans Candida species (NACs) and multidrug-resistant bacteria. A longer length of hospital stay, more severely ill patients, and empirical antimicrobial use in intensive care units (ICUs) increased the prevalence of Candida healthcare-associated infections (HAIs). If the diagnosis or treatment of invasive candidiasis is delayed, the morbidity and mortality of patients will significantly increase. Materials and Methods: We conducted a nationwide surveillance study to analyze data on HAIs in the ICUs of medical centers and regional hospitals between 2018 and 2023. We assessed the temporal trends of Candida species (including Candida albicans and NACs) across all HAIs, bloodstream infections (BSIs), and urinary tract infections (UTIs), and simultaneously assessed the corresponding trends of Enterococcus faecium (Efm). A linear trend for the proportions of microorganisms from 2018 to 2023 was noted according to the Mantel–Haenszel chi-square test. Spearman’s rank correlation coefficients were used to analyze the correlations between pathogen proportions, systemic antimicrobial agent consumption, and length of ICU stay. Results: The overall proportion of all Candida species in HAIs in the ICUs increased significantly from 15.13% to 16.74% (p < 0.001); this increase was driven mainly by NACs (increasing from 6.84% to 7.91%, p < 0.001) from 2018 to 2023. The proportion of Efm increased significantly, from 7.7% to 11.11% (p < 0.001). The proportions of all Candida species significantly increased in UTIs (from 24.63% to 28.13%, p < 0.001), especially NACs, while the proportion of Efm also increased significantly in UTIs (from 9.47% to 15.32%, p < 0.001). With respect to the UTIs, the proportion of all the Candida species, C.albicans, and NACs were positively correlated with the amount of systemic antibiotics used. A longer hospital stay was strongly correlated with all Candida HAIs and UTIs, especially NACs. Significantly ecological associations between all the Candida strains and Efm were observed for UTIs. Conclusions: This study revealed that a persistent expansion of NAC infections was associated with increased Efm infections and rising antibiotic consumption. The changes in the proportions of different Candida species in UTIs were most pronounced. These findings support an ecological model in which antibiotic stress and chronic critical illness contribute to the expansion of fungal–bacterial co-infections in the ICU setting and underscore the need for integrated antibiotic management and multi-infection surveillance. Full article