Resistance patterns and clinical significance of Candida colonization and infection in combat-related injured patients from iraq and afghanistan.
BACKGROUND
Penetrating wounds with environmental contamination are associated with a range of infectious complications, including fungus. This is the first study to examine the epidemiology, resistance patterns, and outcomes of Candida infections and colonization in United States military patients injured in Iraq and Afghanistan.


METHODS
Clinical information associated with initial unique and serial Candida isolates collected from patients (June 2009-October 2013) through the Trauma Infectious Disease Outcomes Study (TIDOS) was evaluated. Susceptibilities were performed using Sensititre YeastOne (YO-9) plates and interpreted by Clinical Laboratory and Standards Institute (CLSI) and adjusted-European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria.


RESULTS
The analysis included 127 patients with 131 unique Candida isolates, of which 102 were Candida albicans and 29 non-albicans Candida spp. Overall, 99% of patients were male with a median age of 23 and an injury severity score of 22. Injuries were primarily due to blasts (77%) and sustained among personnel serving in Afghanistan (89%). There was a median of 7 days from injury to Candida isolation, and 74 isolates were associated with infection. In the multivariate analysis, non-albicans Candida spp were associated with prior antifungal exposure, blood isolates, and wound isolates (P < .01). Nonsusceptibility by CLSI and EUCAST criteria was associated with non-albicans Candida spp (P < .05). Patients with Candida isolation had a 7.1% mortality rate, compared with 1.4% from the overall TIDOS population.


CONCLUSIONS
Candida isolation from patients with penetrating war injuries may identify a population at higher risk for death. Prospective studies are needed to determine whether targeted antifungals and surgical management will affect this mortality rate.
Infectious Disease Service, San Antonio Military Medical Center , Joint Base San Antonio-Fort Sam Houston , Texas.
Dana M
DM
Blyth
Infectious Disease Service, San Antonio Military Medical Center , Joint Base San Antonio-Fort Sam Houston , Texas ; Infectious Disease Clinical Research Program , Uniformed Services University of the Health Sciences ; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.
Katrin
K
Mende
Infectious Disease Clinical Research Program , Uniformed Services University of the Health Sciences ; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. ; Infectious Disease , Walter Reed National Military Medical Center , Bethesda, Maryland.
Amy C
AC
Weintrob
Infectious Disease Service, San Antonio Military Medical Center , Joint Base San Antonio-Fort Sam Houston , Texas.
Miriam L
ML
Beckius
Infectious Disease Service, San Antonio Military Medical Center , Joint Base San Antonio-Fort Sam Houston , Texas ; Infectious Disease Clinical Research Program , Uniformed Services University of the Health Sciences ; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.
Wendy C
WC
Zera
Infectious Disease Service, San Antonio Military Medical Center , Joint Base San Antonio-Fort Sam Houston , Texas ; Infectious Disease Clinical Research Program , Uniformed Services University of the Health Sciences ; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.
William
W
Bradley
Infectious Disease Clinical Research Program , Uniformed Services University of the Health Sciences ; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.
Dan
D
Lu
Infectious Disease Clinical Research Program , Uniformed Services University of the Health Sciences.
David R
DR
Tribble
Infectious Disease Service, San Antonio Military Medical Center , Joint Base San Antonio-Fort Sam Houston , Texas.
Clinton K
CK
Murray
Candida; antifungal resistance; combat-related trauma