Noncandidal, Fungal Infections of the Burn Wound

Burn Wound Infections

“…Endogenous gram-negative bacteria from the patient's gastrointestinal flora also rapidly colonize the burn wound surface in the first few days after injury (266,267,269,357). Wound colonization by yeasts and fungi usually occurs later due to the use of broad-spectrum antibiotic therapy (65,105,123). Microorganisms transmitted from the hospital environment tend to be more resistant to antimicrobial agents than those originating 412 CHURCH ET AL.…”

“…Although Staphylococcus aureus remains a common cause of early burn wound infection, Pseudomonas aeruginosa from the patient's endogenous gastrointestinal flora and/or an environmental source is the most common cause of burn wound infections in many centers (6). The incidence of infections due to less commonly encountered microbes, including other gram-positive and gram-negative bacteria, fungi, and viruses, has also increased steadily in subsequent decades (3,23,37,65,92,105,143,149,360,389) (Table 2). While less common, infections due to anaerobic bacteria typically occur secondary to electrical burns or when open wound dressings are used in place of occlusive dressings (308).…”

“…Burn wound infections due to zygomycetes such as Rhizopus spp. and Mucor spp., although very rare, are important because of their remarkable ability to spread rapidly across fascial tissue planes and to invade the vasculature and are associated with a very high mortality rate (65,424). Diagnosis of fungal infections of burn wounds is most reliably made by histological examination of burn wound tissue samples along with culture of the biopsy sample.…”

“…Diagnosis of fungal infections of burn wounds is most reliably made by histological examination of burn wound tissue samples along with culture of the biopsy sample. Aggressive wide surgical excision of the infected areas of the burn wound before the development of deep invasion, combined with systemic antifungal agents, may lead to an improved chance of survival (65,105,141,424). The use of a laminar-airflow isolation room, in conjunction with optimal local wound care, appears to decrease the incidence of both disseminated and local fungal infection (103,303).…”

Prevention of Infections Associated With Combat-Related Burn Injuries

“…18,22 Candidal colonization of burn wounds is more common than invasive disease and may arise from an endogenous or exogenous source. [31][32][33] The filamentous fungi are uniformly acquired from an exogenous environmental source and are much more likely to cause invasive disease than Candida species. [32][33][34][35][36] The filamentous fungi commonly associated with burn wound sepsis include Aspergillus spp., Fusarium spp., and members of the Mucorales order of the Zygomycetes.…”