Outcome and characteristics of invasive fungal infections in critically ill burn patients: A multicenter retrospective study

Maurel, Véronique; Denis, Blandine; Camby, Matthieu; Jeanne, M.; Cornesse, A.; Glavnik, Boris; Alanio, Alexandre; Rousseau, Anne-Françoise; Lefloch, Ronan; Lagrange-Xélot, Marie; Textoris, Julien; Wiramus, Sandrine; Tymowski, Christian de; Legrand, Matthieu

doi:10.1111/myc.13068

Cited by 15 publications

(6 citation statements)

References 28 publications

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“…Invasive fungal infections are one of the most severe complications in burn patients and associated with poor outcomes ( Maurel et al., 2020 ). Burn wounds are the main sources of fungi in our center, similar to Pakistan ( Jabeen et al., 2020 ).…”

Section: Discussionmentioning

confidence: 99%

“…Several studies show that large burn area and depth, prolonged broad-spectrum antibiotic therapy, and increased postburn days were risk factors of fungal infections in burn patients ( Rafik et al., 2016 ; Jabeen et al., 2020 ). Bacterial coinfection and presence of allografts could further increase the mortality of patients with fungal infections ( Maurel et al., 2020 ). In this study, we also found 45.2% and 58.6% of patients with fungal infection complicated with bacterial infection in BCW and BICU, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Different Infection Profiles and Antimicrobial Resistance Patterns Between Burn ICU and Common Wards

Gong

Peng

Luo

et al. 2021

Front. Cell. Infect. Microbiol.

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Infection is the leading cause of complications and deaths after burns. However, the difference in infection patterns between the burn intensive care unit (BICU) and burn common wards (BCW) have not been clearly investigated. The present study aimed to compare the infection profile, antimicrobial resistance, and their changing patterns in burn patients in BICU and BCW. Clinical samples were analyzed between January 1, 2011, and December 31, 2019, in the Institute of Burn Research in Southwest China. The patient information, pathogen distribution, sources, and antimicrobial resistance were retrospectively collected. A total of 3457 and 4219 strains were detected in BICU and BCW, respectively. Wound secretions accounted for 86.6% and 44.9% in BCW and BICU, respectively. Compared with samples in BCW, samples in BICU had more fungi (11.8% vs. 8.1%), more Gram-negative bacteria (60.0% vs. 50.8%), and less Gram-positive bacteria (28.2% vs. 41.1%). Acinetobacter baumannii were the most common pathogen in BICU, compared with Staphylococcus aureus in BCW. S. aureus was the most frequent pathogen in wound secretions and tissues from both BICU and BCW. However, A. baumannii were the first in blood, sputum, and catheter samples from BICU. Overall, the multidrug-resistance (MDR) rate was higher in BICU than in BCW. However, the gap between BICU and BCW gradually shortened from 2011 to 2019. The prevalence of MDR A. baumannii and Klebsiella pneumonia significantly increased, especially in BCW. Furthermore, Carbapenem resistance among K. pneumoniae significantly increased in BICU (4.5% in 2011 vs. 40% in 2019) and BCW (0 in 2011 vs. 40% in 2019). However, the percentage of MDR P. aeruginosa sharply dropped from 85.7% to 24.5% in BICU. The incidence of MRSA was significantly higher in BICU than in BCW (94.2% vs. 71.0%) and stayed at a high level in BICU (89.5% to 96.3%). C. tropicalis and C. albicans were the two most frequent fungi. No resistance to Amphotericin B was detected. Our study shows that the infection profile is different between BICU and BCW, and multidrug resistance is more serious in BICU than BCW. Therefore, different infection-control strategies should be emphasized in different burn populations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Different Infection Profiles and Antimicrobial Resistance Patterns Between Burn ICU and Common Wards

Gong

Peng

Luo

et al. 2021

Front. Cell. Infect. Microbiol.

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“…3 By rectifying these discrepancies and instituting strategies to augment the accessibility of essential antifungal agents, healthcare institutions can enhance their capacity to handle IFI across a wider range of patients, in line with current guidelines. 15 , 30–34 This holds particular significance given the rising incidence of IFI among immunocompetent individuals, attributable to factors such as travel history to endemic regions, 35 , 36 burns 37 or traumatic injuries, 38 and more recently as a secondary infection to respiratory viral infections, including influenza- or severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2)-associated pulmonary aspergillosis. 9 , 39 …”

Section: Discussionmentioning

confidence: 99%

Insights into invasive fungal infection diagnostic and treatment capacities in tertiary care centres of Germany

Salmanton-García,

Simon,

Groll

et al. 2024

JAC-Antimicrobial Resistance

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Introduction In Germany, the growing incidence of invasive fungal infections (IFIs) is a significant health concern, particularly impacting individuals with compromised immune systems due to factors like increasing transplant recipients, an ageing population, and heightened use of immunosuppressive medications. Diagnosing IFI remains challenging, and the integration of biomarker assays into clinical practice is difficult. Antifungal resistance, exemplified by pan-antifungal-resistant Candida auris cases, adds complexity to treatment. This study aims to provide a concise overview of the diagnostic and treatment landscape for IFI in Germany, identifying areas for improvement and paving the way for targeted interventions. Methods Data were collected using an online electronic case report form from October 2021 to February 2023. The survey included questions about institutional practices related to fungal infection diagnosis and treatment, with invitations extended to researchers nationwide. Results The study surveyed 58 hospitals across Germany. Notably, 77.6% managed high-risk patients for IFI. While 86% had onsite microbiology labs, a significant difference was noted for high-risk patients (93% in specialized hospitals versus 62% in others). Microscopy services had 96% coverage, while overall access to culture was 96%. Antigen tests had 96% coverage, and antibody access was reported at 98%. PCR testing was available at 98%. Imaging access showed no significant access differences. Variability existed in amphotericin B formulations based on patient profiles. Therapeutic drug monitoring was more common in high-risk patient institutions (89.5% versus 50.0%). All analysed institutions reported access to surgery (100%). Conclusions Addressing identified disparities in diagnostic and therapeutic resources for IFI is crucial to improving patient outcomes. The study calls for ongoing research and collaboration to optimize strategies for the prevention and treatment of IFI, emphasizing the importance of equitable access to resources, especially in high-risk patient populations.

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“…In this situation, the positive rate of blood culture is considerably reduced. In addition, the incidence of fungal infections in elderly severe burn patients is very high [ 20 ], and blood cultures are insufficient for fungal detection due to the sensitivity deficiency and slow multiplication [ 21 , 22 ]. As an unbiased DNA/RNA detection method, mNGS is widely used in clinical practice but is rarely used in burn patients [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

Application of mNGS to describe the clinical and microbial characteristics of severe burn a tanker explosion at a tertiary medical center: a retrospective study patients following

Huang

2021

BMC Infect Dis

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Background Multiple organ dysfunction syndrome secondary to infection is the leading cause of death in burn patients. Bloodstream infection (BSI) and the prognosis of burn patients are negatively correlated. Metagenomic next-generation sequencing (mNGS) can detect many potential pathogens and may be more valuable for patients with severe burns. Methods We retrospectively explored the utility of mNGS in describing the clinical and microbial characteristics of severely burned patients with BSI. We compared mNGS with blood culture. Results Fourteen patients (127 blood samples) developed 71 episodes of BSIs with 102 unique causative pathogens. The median total body surface area was 93%. The overall 90-day mortality was 43%. In total, 17 (23.9%) episodes were polymicrobial, and 61 (86.1%) episodes originated from the wound. In total, 62/71 cases (87%) showed positive findings by mNGS, while 42/71 cases (59%) showed positive findings using blood culture. We found that mNGS outperformed culture, especially in terms of fungi (27% vs. 6%, p < 0.0001). Conclusions The incidence of BSI and polymicrobial in patients with large-area severe burns is high. mNGS has potential value in the diagnosis of fungal infections and coinfections in such patients. In addition, mNGS may provide unique guidance for antibiotic therapy in complicated BSI.

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Outcome and characteristics of invasive fungal infections in critically ill burn patients: A multicenter retrospective study

Cited by 15 publications

References 28 publications

Different Infection Profiles and Antimicrobial Resistance Patterns Between Burn ICU and Common Wards

Different Infection Profiles and Antimicrobial Resistance Patterns Between Burn ICU and Common Wards

Insights into invasive fungal infection diagnostic and treatment capacities in tertiary care centres of Germany

Application of mNGS to describe the clinical and microbial characteristics of severe burn a tanker explosion at a tertiary medical center: a retrospective study patients following

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