Fungal sepsis: an increasing problem in major thermal injuries.
In major thermal burns there has been an alarming emergence of fungal sepsis as defined by involvement of three or more organs and/or repeated positive blood cultures. During an 18-month period, we treated 72 patients (aged 18 +/- 2 years; TBSA burn, 57 +/- 3%; percent of third-degree burn, 45 +/- 3) with fungal sepsis. In all patients with documented three-organ involvement, treatment was with intravenous amphotericin (0.5 mg/kg body weight/day), immediate wound debridement, and early wound closure. The mortality was 32% (23 patients); 49 (68%) survived infection. Sixty-two variables were reviewed retrospectively using multiple regression analysis to ascertain specific factors associated with fungal sepsis and their relationship to survival. In burn patients, fungal sepsis is a strong determinant of survival, and its occurrence overshadows traditional factors presently utilized to predict clinical outcome.
Children's Hospital, Boston.
J M
JM
Pensler
D N
DN
Herndon
H
H
Ptak
E
E
Bonds
T C
TC
Rutan
M H
MH
Desai
S
S
Abston
D000293:Adolescent; D000666:Amphotericin B / Q000627:therapeutic use; D002056:Burns / Q000150:complications*; D003646:Debridement; D006801:Humans; D009181:Mycoses / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D014946:Wound Infection / Q000209:etiology* / Q000401:mortality / Q000628:therapy
D000666:Amphotericin B