2014
DOI: 10.1089/sur.2013.123
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Risk Factors Associated with Invasive Fungal Infections in Combat Trauma

Abstract: Background: In recent years, invasive fungal infections (IFI) have complicated the clinical course of patients with combat-related injuries. Commonalities in injury patterns and characteristics among patients with IFI led to the development of a Joint Trauma System ( JTS) clinical practice guideline (CPG) for IFI management. We performed a case-control study to confirm and further delineate risk factors associated with IFI development in combat casualties with the objective of generating data to refine the CPG… Show more

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Cited by 50 publications
(44 citation statements)
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“…Specifically, times to wound closure for IFI wounds were significantly longer than those for wounds with SSTIs but lacking fungal infection. This complexity is likely due to the magnitude of tissue loss and severity of the blast injury, along with virulence and tissue destruction due to mold infection (11). While this finding highlights the morbidity of molds in trauma wounds in general, the longer times to wound closure for Mucorales infections suggests increased pathogenicity of this mold type in these wounds.…”
Section: Discussionmentioning
confidence: 93%
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“…Specifically, times to wound closure for IFI wounds were significantly longer than those for wounds with SSTIs but lacking fungal infection. This complexity is likely due to the magnitude of tissue loss and severity of the blast injury, along with virulence and tissue destruction due to mold infection (11). While this finding highlights the morbidity of molds in trauma wounds in general, the longer times to wound closure for Mucorales infections suggests increased pathogenicity of this mold type in these wounds.…”
Section: Discussionmentioning
confidence: 93%
“…Further analyses have examined risk factors, clinical outcomes, and the effect of an early IFI diagnosis practice guidance (10,11). In a recent analysis, IFI case patients had significantly greater residual limb shortening, more amputation level revisions, and a longer time to initial wound closure than a control patient group without fungal-infected wounds matched on injury pattern (12).…”
mentioning
confidence: 99%
“…The infected tissue has a grayish appearance, and the diagnosis is verified by biopsy and fungal cultures. Independent risk factors for developing IFI have been shown to be blast injury while on foot patrol, above knee amputations, and massive transfusions (>20 units) of packed red blood cells within 24 h post-injury [42]. IFI must be treated with serial, aggressive debridement and often result in the loss of large volumes of muscle tissue, as well as length of the residual limb.…”
Section: Infectionmentioning
confidence: 99%
“…Blast injuries from IEDs have the potential for severe disruption of skin and bone and contamination of wounds with organic material such as soil and plant matter (13). Risk factors associated with IFIs include dismounted injuries while on foot patrol and large-volume blood transfusions (11,14).…”
mentioning
confidence: 99%
“…Notably, large-volume PRBC transfusion (Ͼ20 units) may represent a marker for severe disease rather than an independent risk factor (14).…”
mentioning
confidence: 99%