Candidemia in trauma patients is often preceded by mucosal colonization, and generally occurs in less than 10% of patients. We evaluated 21 patients who were injured by a bomb explosion in a vegetable market. Thirteen (62%) patients had second and third degree burns ranging from 7%-65% (mean 28%) of total body surface area, and 9 (43%) patients suffered inhalation injury. Penetrating shrapnel injuries, produced by rusty nails inserted in the bomb, occurred in 20 (95%) patients, resulting mainly in soft tissue damage, without gastrointestinal injury. Twenty (95%) patients underwent operations, primarily for removal of shrapnel and debridement. Twelve (57%) patients were admitted to general ICU, with a mean stay of 14 days. Early (1-3 d) respiratory colonization with Aspergillus or Rhizopus species was demonstrated in 4 (19%) patients. Candidemia occurred in 7 (30%) patients ( 58% of those admitted to ICU) between 4 to 16 d (mean 12 d) after the injury. Isolates included C. tropicalis (3 patients), C. parapsilosis (2 patients) and C. albicans (2 patients). Candida sp. was the single most frequent cause of bloodstream infections, and was preceded by mucosal colonization in only one patient. Patients with candidemia were characterized by extensive burns and inhalation injury. Overall mortality was 14%, and mortality among patients with candidemia was 43%. Candidemia in this group of blast patients occurred at a significantly higher rate than in comparable trauma patients injured in a different setting (1 of 32; p=0.004), and in non-trauma ICU patients (1 of 20; p=0.04) during the same period. These findings suggest a role for an exogenous environmental source in the development of invasive fungal infections in some trauma patients, and indicate the need to consider early preemptive antifungal therapy for patients sustaining trauma in a similar setting.
Full conference title:
38th Interscience Conference on Antimicrobial Agents and Chemotherapy
- ICAAC 38th