Spectrum of Fungal Pathogens in Burn Wound Specimens: Data From a Tertiary Care Hospital Laboratory in Pakistan

Abstract

Burn patients are at great risk of developing fungal wound infections. Fungi are frequently cultured from burn tissue specimens alone or in combination with bacteria. However, the spectrum of fungi in burn patients from Pakistan has not been reported previously. A retrospective laboratory-based study was conducted and data on all positive cultures from burn wounds were included. During the study period, specimens were cultured on appropriate media and incubated for anaerobic and aerobic growth. Clinical and demographic information recorded during clinical reporting was also collected. Seventy tissue cultures were positive for microorganisms. Of these, 27 (39%) had growth of either filamentous mold (17 cases) or Candida species (14 cases). Two cases had growth of both mold and yeast. Aspergillus flavus was the most common mold (9) followed by Fusarium species (3). Candida tropicalis was the most common yeast (7) followed by Candida parapsilosis (4). There was concomitant bacterial growth in 19 cases, predominantly of Staphylococcus aureus (13), Pseudomonas aeruginosa (8), and other Gram-negative rods (6). Of the 35 patients in which treatment history was available, 33 were receiving broad spectrum antibiotics. A high incidence of fungal isolation was seen in this study. Our findings are consistent with the global increase in fungal infections in burn wounds. High index of suspicion by clinicians and revision of culture protocols in burn patients may be warranted for optimal patient management.

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

“…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 ). However, the incidence of fungal infection is lower in our center (11.8% in BICU and 8.1% in BCW) than in India (26%) ( Sharma et al., 2016 ) and similar to that in Morocco (10%) ( Rafik et al., 2016 ).…”

“…Therefore, it is important to recognize burn patients with high risk factors of fungal infection. 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 ).…”

Epidemiology and Early Bacteriology of Extremely Severe Burns from an LPG Tanker Explosion in Eastern China

“…Moreover, the study observed that fungal infections appeared earlier (after 1.75 days) than those previously reported [ 6 , 24 ] to present 2 or 3 weeks after admission. In this study, the most common fungus isolated from wounds was Fusarium .…”

“…should be disinfected at least three times a day and be dedicated, ( 5) and final disinfection of ward following the discharge of patient, should be entire, and so on. Moreover, the study observed that fungal infections appeared earlier (after 1.75 days) than those previously reported [6,24] to present 2 or 3 weeks after admission. In this study, the most common fungus isolated from wounds was Fusarium.…”

Fungal isolation from wound samples submitted for culture at a tertiary care hospital laboratory

“…A high rate of fungal isolation in burn patients [27 of 70 (39%)] has also been reported from Pakistan which is consistent with global data and the current study. 8 Similarly, fungal infections in blast and other accidental trauma are emerging as serious complications leading to high morbidity and mortality. [4][5] Fungi are prevalent in the environment, leading to contamination of open wound after trauma, especially after road traffic accidents, burns, blast injury, and other disasters.…”