FIRE: Fungal Infection Risk Evaluation


There is evidence that fungal infections are more likely to occur in patients in critical care units.  A number of research studies have evaluated treatments to prevent fungal infection in critically ill patients, and have shown that these treatments reduce the risk of fungal infection and possibly reduce the number of deaths from fungal infection. 

The aim of the FIRE Study was to develop methods to identify critically ill adult patients at high risk of fungal infection, who would benefit from preventative treatment and to assess the cost-effectiveness of targeting antifungal treatments to high-risk patients. 


96 UK adult general critical care units took part in the study and collected data on 60,778 patients admitted to the critical care unit between July 2009 and March 2011.


There was a low incidence of fungal infection among critically ill adult patients. However the death rate was higher in those patients with fungal infection.  The study found that the most cost-effective treatment strategy for critically ill adult patients admitted to NHS critical care units is to assess the risk of developing fungal infection and give preventative treatment, if needed, to patients who have been in the critical care unit for three days.  


This finding is highly uncertain and future studies should consider the potential impact of increased resistance to antifungal drugs.

Who led the study?

Professor David Harrison, ICNARC

The study was funded by the National Institute for Health Research (NIHR) – Health Technology Assessment (HTA) Programme (Project: 07/29/01)


Patterson L, McMullan R, Harrison DA. Individual risk factors and critical care unit effects on Invasive Candida Infection occurring in critical care units in the UK: A multilevel model. Mycoses 2019; 62(9):790-5.

Theocharidou E, Agarwal B, Jeffrey G, Jalan R, Harrison D, Burroughs AK, Kibbler CC. Early invasive fungal infections and colonization in patients with cirrhosis admitted to the intensive care unit. Clin Microbiol Infect 2016; 22(2):189 e1-7.

Shahin J, Allen EJ, Patel K, Muskett H, Harvey SE, Edgeworth J, Kibbler CC, Barnes RA, Biswas S, Soni N, Rowan KM, Harrison DA. Predicting invasive fungal disease due to Candida species in non-neutropenic, critically ill, adult patients in United Kingdom critical care units. BMC Infect Dis 2016; 16:480.

Sadique Z, Grieve R, Harrison DA, Jit M, Allen E, Rowan KM. An integrated approach to evaluating alternative risk prediction strategies: a case study comparing alternative approaches for preventing invasive fungal disease. Value Health 2013; 16(8):1111-22.

Harrison D, Muskett H, Harvey S, Grieve R, Shahin J, Patel K, Sadique Z, Allen E, Dybowski R, Jit M, Edgeworth J, Kibbler C, Barnes R, Soni N, Rowan K. Development and validation of a risk model for identification of non-neutropenic, critically ill adult patients at high risk of invasive Candida infection: the Fungal Infection Risk Evaluation (FIRE) Study. Health Technol Assess 2013; 17(3):1-156.

Muskett H, Shahin J, Eyres G, Harvey S, Rowan K, Harrison D. Risk factors for invasive fungal disease in critically ill adult patients: a systematic review. Crit Care 2011; 15(6):R287.