title: Mucormycosis attributed mortality: a seven-year review of surgical and medical management.
abstract: BACKGROUND
  Historically, mucormycosis infections have been associated with high mortality. The purpose of this study was to determine the incidence, associated mortality, and management strategies of mucormycosis in a major burn center.
  
  
  METHODS
  A retrospective review was performed via obtaining all patients with mucormycosis admitted from January 2003 to November 2009 at our adult burn center was performed obtaining demographic data relevant to fungal burn wound infection or colonization.
  
  
  RESULTS
  The incidence of mucormycosis at our facility was 4.9 per 1000 admissions; specifically, 11 military casualties and one civilian were diagnosed with mucormycosis. The median percentage Total Body Surface Area (TBSA) burned, 11 patients, or open wound, one patient, was 60 (IQR, 54.1-80.0), and the incidence of documented inhalation injury was 66.7% (8 of 12). Ten patients had surgical amputations. A median of eight days (IQR, 3.5-74.5) elapsed from diagnosis of mucormycosis until death in the 11 patients who expired. The overall mortality was 92%; however, autopsy attributed mucormycosis mortality was 54.5% (6 of 11) with all six patients having invasive mucormycosis.
  
  
  CONCLUSIONS
  Aggressive surgical intervention should be undertaken for invasive mucormycosis; additionally, implementation of standardized protocols for patients with large soft tissue injuries may mitigate mucormycosis superimposition.
authors.affiliation: Brooke Army Medical Center, Fort Sam Houston, TX, United States.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Mitchell
authors.affiliation: Brooke Army Medical Center, Fort Sam Houston, TX, United States.
authors.forename: Mark O
authors.initials: MO
authors.lastname: Hardin
authors.affiliation: Brooke Army Medical Center, Fort Sam Houston, TX, United States.
authors.forename: Clinton K
authors.initials: CK
authors.lastname: Murray
authors.affiliation: Brooke Army Medical Center, Fort Sam Houston, TX, United States.
authors.forename: John D
authors.initials: JD
authors.lastname: Ritchie
authors.affiliation: Brooke Army Medical Center, Fort Sam Houston, TX, United States.
authors.forename: Leopoldo C
authors.initials: LC
authors.lastname: Cancio
authors.affiliation: Brooke Army Medical Center, Fort Sam Houston, TX, United States.
authors.forename: Evan M
authors.initials: EM
authors.lastname: Renz
authors.affiliation: Brooke Army Medical Center, Fort Sam Houston, TX, United States. Electronic address: christopher.eric.white@us.army.mil.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: White
mesh_terms: D000328:Adult; D000671:Amputation, Surgical; D000935:Antifungal Agents / Q000627:therapeutic use*; D001753:Blast Injuries / Q000150:complications / Q000628:therapy*; D001830:Body Surface Area; D002053:Burn Units; D002056:Burns / Q000150:complications / Q000628:therapy*; D002059:Burns, Inhalation / Q000150:complications / Q000628:therapy; D003646:Debridement; D006801:Humans; D008889:Military Personnel / Q000706:statistics & numerical data*; D009091:Mucormycosis / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D015599:Trauma Severity Indices; D014946:Wound Infection / Q000209:etiology / Q000401:mortality* / Q000628:therapy; D055815:Young Adult
chemical_list: D000935:Antifungal Agents
keywords: Amputation; Combat; Fungal wound colonization; Fungal wound infection; Mucormycosis; Trauma; War