High Rates of Dissemination and Mortality among Burn Patients with Fungal Wound Infections

KATHERINE G. BANULL, MD, CORNELIUS J. CLANCY, MD and M. HONG NGUYEN, MD,

Author address: 

Univ. of Florida, Gainesville, FL

Abstract: 

Fungal infections (FI) are increasingly recognized among burn patients. We reviewed admissions to our burn unit from 1994 to 2003 and identified 16 patients with FI. The median age was 44.5 years (17-82 years). Four patients were alcoholics and intoxicated at the time of burn, one had diabetes, and one was pregnant. The causes of burn were: house fire (7), camp or trash fire (4), car fire (2), BBQ-related (1), airplane crash and fire (1) and munitions factory explosion (1). All patients had 2nd or 3rd degree burns, and median TBSA involvement was 62.5% (20-97%). 14 patients had documented wound infections; 2 had candidemia but no fungi isolated from wounds. Two patients were diagnosed by histopathologic evidence of angio-invasive hyphae; cultures were not performed. 11 had () blood cultures, of whom 7 also had () wound cultures (4 Candida, 2 Fusarium, 1 Trichosporon). Five had () wound cultures alone. Tissue necrosis was noted in 8 infected wounds, graft failure in 6 and purulence in 3. Six infections were due to yeast (all Candida spp.), 5 mould (2 Fusarium, 1 Aspergillus, 2 culture not done) and 5 yeast and mould (Candida, Trichosporun, Fusarium, Aspergillus, Rhizopus). Yeast infections developed earlier than mould (median days from burn to FI: 14.5 for yeast, 30 for mould). 2 patients had concomitant bacterial wound infections. 13 patients had disseminated FI; the wound served as portal for 12. 15 patients had repeated wound debridements. 15 patients had systemic antifungal therapy: AmB (7), fluconazole (3), AmB plus fluconazole (4), AmB plus voriconazole (1). In 2 patients with clinical suspicion of fungal burn wound, topical nystatin was given initially. Systemic antifungal therapy was started only after the culture/histopath revealed FI. Ten patients died, all of whom had disseminated FI; the mortality rate among those with disseminated FI was 77%. 5 patients had active FI at death. In conclusion, the vast majority of fungal wound infections led to dissemination, which was associated with high mortality. Early intervention with aggressive surgical debridements and systemic antifungal agent is the key to improving outcome.
2003

abstract No: 

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Full conference title: 

41st Annual Meeting Infectious Diseases Society of America
    • Infectious Diseases Society of America 41st