title: Candidemia in major burns patients.
abstract: Major burn patients have characteristics that make them especially susceptible to candidemia, but few studies focused on this have been published. The objectives were to evaluate the epidemiological, microbiological and clinical aspects of candidemia in major burn patients, determining factors associated with a poorer prognosis and mortality. We conducted a retrospective observational study of candidemia between 1996 and 2012 in major burn patients admitted to the La Fe University Hospital, Valencia, Spain. The study included 36 episodes of candidemia in the same number of patients, 55.6% men, mean age 37.33 years and low associated comorbidity. The incidence of candidemia varied between 0.26 and 6.09 episodes/1000 days stay in the different years studied. Candida albicans was the most common species (61.1%) followed by Candida parapsilosis (27.8%). Candidemia by C. krusei, C. glabrata or C. tropicalis were all identified after 2004. Central vascular catheter (CVC) was established as a potential source of candidemia in 36.1%, followed by skin and soft tissues of thermal injury (22.2%) and urinary tract (8.3%). Fluconazole was used in 19 patients (52.7%) and its in vitro resistance rate was 13.9%. The overall mortality was 47.2%, and mortality related to candidemia was 30.6%. Factors associated with increased mortality were those related to severe infection and shock. CVC was the most usual focus of candidemia. Fluconazole was the most common antifungal drug administered. The management of candidemia in major burn patients is still a challenge.
authors.affiliation: Internal Medicine Department (Medical Clinic Area), La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Ana I
authors.initials: AI
authors.lastname: Renau Escrig
authors.affiliation: Infectious Diseases Unit (Medical Clinic Area), La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Salavert
authors.affiliation: Major Burns Unit, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Vivó
authors.affiliation: Experimental Microbiology Unit, Research Centre, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Emilia
authors.initials: E
authors.lastname: Cantón
authors.affiliation: Major Burns Unit, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: M Dolores
authors.initials: MD
authors.lastname: Pérez Del Caz
authors.affiliation: Mycology Unit, Microbiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Pemán
mesh_terms: D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D002056:Burns / Q000150:complications / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality; D002175:Candida / Q000302:isolation & purification; D002176:Candida albicans / Q000302:isolation & purification; D041221:Candida glabrata / Q000302:isolation & purification; D041022:Candida tropicalis / Q000302:isolation & purification; D058387:Candidemia / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D062905:Central Venous Catheters / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D025141:Drug Resistance, Fungal; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013030:Spain / Q000453:epidemiology; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014551:Urinary Tract / Q000382:microbiology
chemical_list: D000935:Antifungal Agents
keywords: Candidemia; major burns patients; mortality; severe thermal injury; vascular catheter