Invasive fungal infections (IFI) are a relevant cause of morbidity and mortality in immunocompromised patients, especially transplant recipients. Their incidence has increased due to longer survival and prolonged use of immunosuppressive agents. The main pathogens are Candida spp., Aspergillus spp., and, less frequently, Mucorales. In Brazil, the public Unified Health System (SUS) is responsible for most transplants and for providing high-cost antifungals, although there are still few national studies quantifying and characterizing these infections. Ecological study using secondary data from the SIH/SUS database for the period from January 2015 to March 2024. Hospitalizations with ICD-10 codes indicative of invasive fungal infections in transplant patients were analyzed. Information was grouped by year, region, and type of agent when available. Hospitalization rates per 100,000 transplant recipients and hospital case-fatality rates were calculated. Between 2015 and 2024, 8,472 hospitalizations for IFI in transplant patients were recorded in Brazil. The annual average was 847 cases, with a peak in 2021 (1,039 cases). The mean hospital case-fatality rate was 28.5%, ranging from 25% to 32% over the years analyzed. The Southeast and South regions accounted for most cases, with 42% and 27% of the total, respectively. The North region had the lowest proportion (6%). The most frequently identified agents were Candida spp. (61%) and Aspergillus spp. (29%). The hospitalization rate per 100,000 transplant recipients increased progressively between 2015 and 2021, with a decline after 2022, coinciding with expanded access to antifungal prophylaxis in transplant centers. Use of liposomal amphotericin B remained restricted to high-complexity hospitals in the South and Southeast. This study confirms that IFI are frequent and severe complications in transplant patients in Brazil, with high hospital case-fatality. It highlights the need for antifungal prophylaxis, early diagnosis, and investments in prevention. There is regional inequality in IFI management, related to access to medications and infrastructure. The concentration of cases in more developed regions may reflect both a higher number of transplants and better reporting. Based on SUS data (2015–2024), the findings reinforce the urgency of public policies that ensure equity and expanded use of surveillance data to guide national strategies.
Stocki et al. (Sun,) studied this question.