Fungal wound infection (not colonization) is independently associated with mortality in burn patients.
OBJECTIVE
To analyze the occurrence of fungal wound infection (FWI) after thermal injury and its relationship to mortality.


BACKGROUND
FWI is an uncommon but potentially lethal complication of severe thermal injury.


METHODS
The records of patients with thermal burns admitted to a single burn center (1991-2002) were reviewed. Analyses accounted for total burn size (TBS, percentage body surface area), full-thickness burn size (FTBS, percentage body surface area), age, inhalation injury, sex, and fungal-status category. Fungal colonization and infection were determined histopathologically.


RESULTS
Criteria for inclusion were met by 2651 patients. Each patient's fungal-status category was defined according to the deepest level of fungal involvement observed during the hospital course: no fungus (2476 patients), fungal wound colonization (FWC, 121 patients), or fungal wound infection (FWI, 54 patients). Median TBS (9%, 47%, 64%, respectively) and mortality (5%, 27%, 76%, respectively) varied significantly among fungal-status groups. Logistic regression was used to detect significant independent associations. FWI was associated with higher TBS. Mortality was associated with TBS, FTBS, inhalation injury, FWI, and age. Unlike FWI, FWC was not independently related to mortality, the greater observed mortality in FWC being explained by other variables such as TBS. The odds ratio for FWI (8.16) suggested about the same mortality impact as augmenting TBS by 33%. A midrange TBS of 30% to 60% was required for most of the detectable association of FWI with mortality.


CONCLUSIONS
FWI accompanies larger burns and is associated with mortality in burn patients, particularly in those with TBS 30% to 60%. This association is independent of burn size, inhalation injury, and age.
Horvath
Edward E
EE
U.S. Army Institute of Surgical Research, Brooke Army Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA.
Murray
Clinton K
CK
Vaughan
George M
GM
Chung
Kevin K
KK
Hospenthal
Duane R
DR
Wade
Charles E
CE
Holcomb
John B
JB
Wolf
Steven E
SE
Mason
Arthur D
AD
Cancio
Leopoldo C
LC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002056:Burns / Q000382:microbiology* / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D009181:Mycoses / Q000382:microbiology* / Q000401:mortality*; D014946:Wound Infection / Q000382:microbiology* / Q000401:mortality*