title: Combat trauma-associated invasive fungal wound infections: epidemiology and clinical classification.
abstract: The emergence of invasive fungal wound infections (IFIs) in combat casualties led to development of a combat trauma-specific IFI case definition and classification. Prospective data were collected from 1133 US military personnel injured in Afghanistan (June 2009-August 2011). The IFI rates ranged from 0·2% to 11·7% among ward and intensive care unit admissions, respectively (6·8% overall). Seventy-seven IFI cases were classified as proven/probable (n = 54) and possible/unclassifiable (n = 23) and compared in a case-case analysis. There was no difference in clinical characteristics between the proven/probable and possible/unclassifiable cases. Possible IFI cases had shorter time to diagnosis (P = 0·02) and initiation of antifungal therapy (P = 0·05) and fewer operative visits (P = 0·002) compared to proven/probable cases, but clinical outcomes were similar between the groups. Although the trauma-related IFI classification scheme did not provide prognostic information, it is an effective tool for clinical and epidemiological surveillance and research.
authors.affiliation: Walter Reed National Military Medical Center,Bethesda, MD,USA.
authors.forename: A C
authors.initials: AC
authors.lastname: Weintrob
authors.affiliation: Walter Reed National Military Medical Center,Bethesda, MD,USA.
authors.forename: A B
authors.initials: AB
authors.lastname: Weisbrod
authors.affiliation: Department of Surgery,Uniformed Services University of the Health Sciences,Bethesda, MD,USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Dunne
authors.affiliation: Walter Reed National Military Medical Center,Bethesda, MD,USA.
authors.forename: C J
authors.initials: CJ
authors.lastname: Rodriguez
authors.affiliation: Walter Reed National Military Medical Center,Bethesda, MD,USA.
authors.forename: D
authors.initials: D
authors.lastname: Malone
authors.affiliation: Landstuhl Regional Medical Center,Landstuhl,Germany.
authors.forename: B A
authors.initials: BA
authors.lastname: Lloyd
authors.affiliation: Walter Reed National Military Medical Center,Bethesda, MD,USA.
authors.forename: T E
authors.initials: TE
authors.lastname: Warkentien
authors.affiliation: Walter Reed National Military Medical Center,Bethesda, MD,USA.
authors.forename: J
authors.initials: J
authors.lastname: Wells
authors.affiliation: San Antonio Military Medical Center,Fort Sam Houston, TX,USA.
authors.forename: C K
authors.initials: CK
authors.lastname: Murray
authors.affiliation: Infectious Disease Clinical Research Program,Uniformed Services University of the Health Sciences,Bethesda, MD,USA.
authors.forename: W
authors.initials: W
authors.lastname: Bradley
authors.affiliation: Infectious Disease Clinical Research Program,Uniformed Services University of the Health Sciences,Bethesda, MD,USA.
authors.forename: F
authors.initials: F
authors.lastname: Shaikh
authors.affiliation: Infectious Disease Clinical Research Program,Uniformed Services University of the Health Sciences,Bethesda, MD,USA.
authors.forename: J
authors.initials: J
authors.lastname: Shah
authors.affiliation: Infectious Disease Clinical Research Program,Uniformed Services University of the Health Sciences,Bethesda, MD,USA.
authors.forename: D
authors.initials: D
authors.lastname: Aggarwal
authors.affiliation: Infectious Disease Clinical Research Program,Uniformed Services University of the Health Sciences,Bethesda, MD,USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Carson
authors.affiliation: Infectious Disease Clinical Research Program,Uniformed Services University of the Health Sciences,Bethesda, MD,USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Tribble
mesh_terms: D000328:Adult; D000346:Afghanistan; D000935:Antifungal Agents / Q000627:therapeutic use; D016469:Fungemia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008889:Military Personnel; D011379:Prognosis; D014481:United States; D014946:Wound Infection / Q000150:complications* / Q000453:epidemiology*; D014947:Wounds and Injuries / Q000150:complications*; D055815:Young Adult
chemical_list: D000935:Antifungal Agents