Positive Fungal Cultures in Burn Patients - A Multicenter Review

Ballard, James; Edelman, Linda S.; Saffle, Jeffrey R.; Sheridan, Robert L.; Kagan, Richard J.; Bracco, Danielle; Cancio, Leopoldo C.; Cairns, Bruce A.; Baker, Rose K.; Fillari, Paula; Wibbenmeyer, Lucy; Voight, David; Palmieri, Tina L; Greenhalgh, David; Kemalyan, Nathan; Caruso, Daniel

doi:10.1097/01253092-200603001-00090

Cited by 11 publications

(22 citation statements)

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“…A reason for this observation might be an increased early use of broad-spectrum antibacterial agents [1,2,9]. Septic complications due to fungal infections in burn patients represent a therapeutic and diagnostic challenge and are associated with high mortality rates [2,10].…”

Section: Introductionmentioning

confidence: 98%

“…In the past, it was suggested that the risk for candidemia increases with a greater total burn surface area (TBSA), burn-associated hyperglycemia, the usage of central venous catheters, the occurrence of bacteremia and prior antibacterial therapy, advanced patient age and a longer hospital stay [2,9,[13][14][15][16].…”

Section: Introductionmentioning

confidence: 99%

“…Septic complications due to fungal infections in burn patients represent a therapeutic and diagnostic challenge and are associated with high mortality rates [2,10]. As main fungal pathogen, Candida albicans is the fourth most common pathogen isolated from blood cultures in an intensive care setting [2,9,11,12].…”

Section: Introductionmentioning

confidence: 99%

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Predisposing factors for candidemia in patients with major burns

Fochtmann

Forstner

Hagmann

et al. 2015

Burns

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Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

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Predisposing factors for candidemia in patients with major burns

Fochtmann

Forstner

Hagmann

et al. 2015

Burns

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“…This has resulted in a surge in invasive fungal infection, which has been linked to higher death rates regardless of the extent of the burn, coincident inhalation injury, or patient age [28]. In a recent review of 15 burn units, fungi were isolated at least once from 6.3% of 6,918 patients [29], with positive cultures being obtained most commonly from the wound itself followed by (in order of decreasing frequency) respiratory, urine, and blood specimens.…”

Section: Gram-negative Bacteriamentioning

confidence: 99%

Infection in Burns

Norbury

Herndon

Tanksley

et al. 2016

Surgical Infections

241

158

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Background: Developments in critical care and surgical approaches to treating burn wounds, together with newer antimicrobial treatments, have significantly reduced the morbidity and mortality rates associated with this injury. Methods: Review of the pertinent English-language literature. Results: Several resistant organisms have emerged as the maleficent cause of invasive infection in burn patients, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, Pseudomonas, Acinetobacter, non-albicans Candida spp., and Aspergillus. Advances in antimicrobial therapies and the release of new classes of antibiotics have certainly added to the armamentarium of therapeutic resources for the clinician. Conclusion: Strict infection control measures, constant wound surveillance with regular sampling of tissues for quantitative culture, and early excision and wound closure remain the principal adjuncts to control of invasive infections in burn patients.

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“…A recently published multi-center retrospective study reviewed all patients admitted to 15 burn centers over a twoyear period who had positive fungal cultures [55]. Patients were divided into three groups on the basis of the treatment: Prophylactic only (topical or oral nystatin), non-systemic treatment including burn excision plus topical agents, and systemic treatment.…”

Section: Fungal Infectionsmentioning

confidence: 99%

Emerging Infections in Burns

Branski

Al-Mousawi

Rivero

et al. 2009

Surgical Infections

279

174

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Background: Patients who suffer severe burns are at higher risk for local and systemic infections. In recent years, emerging resistant pathogens have forced burn care providers world wide to search for alternative forms of treatment. Multidrug-resistant Staphylococcus aureus, Pseudomonas aeruginosa, Acinetobacter spp., and various fungal strains have been the major contributors to the increase in morbidity and mortality rates. Multi-drugresistant S. aureus remains the major cause of gram-positive burn wound infections world wide. Treatment strategies include rigorous isolation protocols and new types of antibiotics where necessary. Methods: We reviewed 398 severely burned patients (burns >40% total body surface area [TBSA]) admitted to our hospital between 2000 and 2006. Patients who did not contract multi-drug-resistant gram-negative organisms during their hospital course and received our standard antibiotic regimen-vancomycin and piperacillin= tazobactam-served as controls (piperacillin=tazobactam; n ¼ 280). The treatment group consisted of patients who, during their acute hospital stay, developed infections with multi-drug-resistant gram-negative pathogens and were treated with vancomycin and colistin for at least three days (colistin; n ¼ 118). Results: Gram-negative organisms continue to cause the most severe infections in burn patients. Colistin has reemerged as a highly effective antibiotic against multiresistant Pseudomonas and Acinetobacter infections of burns. Patients who required colistin therapy had a significantly larger average total and full-thickness burn than patients treated with piperacillin=tazobactam and vancomycin, and the mortality rate was significantly higher in the colistin group (p < 0.05). However, there was no significant difference between the colistin and piperacillin= tazobactam groups in the incidence of neurotoxicity, hepatic toxicity, or nephrotoxicity. The main fungal pathogens in burn patients are Candida spp., Aspergillus spp., and Fusarium spp. A definitive diagnosis is more difficult to obtain than in bacterial infections. Amphotericin B and voriconazole remain the two most important anti-fungal substances in our practice. Conclusions: Innovations in fluid management, ventilatory support, surgical care, and antimicrobial therapy have contributed to a significant reduction in morbidity and mortality rates in burn patients. Vancomycin and clindamycin are the two most important reserve antibiotics for methicillin-resistant Staphylococcus aureus infection. Oxazolidinones and streptogramins have showed high effectiveness against gram-positive infections. Colistin has re-emerged as a highly effective antibiotic against multiresistant Pseudomonas and Acinetobacter infections. Current challenges include Candida, Aspergillus, and molds. The development of new agents, prudent and appropriate use of antibiotics, and better infection control protocols are paramount in the ongoing battle against multi-resistant organisms.

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Positive Fungal Cultures in Burn Patients - A Multicenter Review

Cited by 11 publications

References 0 publications

Predisposing factors for candidemia in patients with major burns

Predisposing factors for candidemia in patients with major burns

Infection in Burns

Emerging Infections in Burns

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