title: Incidence of systemic fungal infection and related mortality following severe burns.
abstract: Advancements in burn care therapy have extended survival of seriously burned patients, exposing burn patients to increased risk of infectious complications, notably fungal infections. We performed a 12-year review of autopsied patients with severe burns for the presence of fungal infection at the US Army Institute of Surgical Research Burn Center between February 1991 and November 2003. The primary goal was to identify the relationship between fungal element noted in autopsy and mortality, and to determine contributing factors that increase a patient's susceptibility to fungal infection. A total of 228 deaths (6.1%) resulted from the 3751 admissions of which 97 underwent autopsy. Fungal elements were identified on histopathology in 44% (43 of 97) of autopsied patients with an attributable mortality of 33% (14 of 43). Aspergillus and Candida were the most frequently recovered fungi, but Aspergillus was recovered in 13 of the 14 cases with fungus identified as an attributable cause of death. The most common sites of infections with attributable mortality were wounds (86%) and the pulmonary system (14%). Total body surface area (TBSA) burn and length of stay (survival after burn) were identified as contributing factors for the incidence of fungal element in autopsy on ROC curve analysis. More severely injured patients with greater %TBSA burn injury and full-thickness burns require a longer recovery period resulting in a longer hospital stay. The propensity for fungal infection increases the longer the wound is present. Therefore, the development of products to close the wound more rapidly, improvement in topical antifungal therapy with mold activity for treating wounds, and implementation of appropriate systemic antifungal therapy may improve outcome for severely injured burn victims susceptible to fungal infections.
authors.affiliation: Infectious Disease Service, San Antonio Military Medical Center, Brooke Army Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234, USA. Clinton.Murray@amedd.army.mil
authors.forename: Clinton K
authors.initials: CK
authors.lastname: Murray
authors.forename: Florence L
authors.initials: FL
authors.lastname: Loo
authors.forename: Duane R
authors.initials: DR
authors.lastname: Hospenthal
authors.forename: Leopoldo C
authors.initials: LC
authors.lastname: Cancio
authors.forename: John A
authors.initials: JA
authors.lastname: Jones
authors.forename: Seung H
authors.initials: SH
authors.lastname: Kim
authors.forename: John B
authors.initials: JB
authors.lastname: Holcomb
authors.forename: Charles E
authors.initials: CE
authors.lastname: Wade
authors.forename: Steven E
authors.initials: SE
authors.lastname: Wolf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001230:Aspergillus / Q000302:isolation & purification; D001344:Autopsy; D001830:Body Surface Area; D002056:Burns / Q000382:microbiology / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D015994:Incidence; D007902:Length of Stay; D008172:Lung Diseases, Fungal / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013781:Texas / Q000453:epidemiology; D014946:Wound Infection / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D055815:Young Adult