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Volume 25, Number 9—September 2019
CME ACTIVITY - Synopsis

Classification of Trauma-Associated Invasive Fungal Infections to Support Wound Treatment Decisions

Anuradha GanesanComments to Author , Faraz Shaikh, William Bradley, Dana M. Blyth, Denise Bennett, Joseph L. Petfield, M. Leigh Carson, Justin M. Wells, David R. Tribble, and Infectious Disease Clinical Research Program Trauma Infectious Disease Outcomes Study Group
Author affiliations: The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA (A. Ganesan, F. Shaikh, W. Bradley, D. Bennett, M.L. Carson); Uniformed Services University of the Health Sciences, Bethesda (A. Ganesan, F. Shaikh, W. Bradley, D. Bennett, M.L. Carson, D.R. Tribble); Walter Reed National Military Medical Center, Bethesda (A. Ganesan, J.M. Wells); Brooke Army Medical Center, San Antonio, Texas, USA (W. Bradley, D.M. Blyth); Landstuhl Regional Medical Center, Landstuhl, Germany (J.L. Petfield)

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Table 3

Characteristics of US military patients with laboratory evidence of invasive fungal infection of wound sustained on battlefield, Afghanistan, June 1, 2009–December 31, 2014*

Characteristic IFI, n = 94 High suspicion, n = 61 p value† Low suspicion, n = 91 p value‡
Blast injury 92 (97.9) 61 (100) 0.520 89 (97.8) 1.000
Injured while on foot patrol§
73 (94.8)
51 (94.4)
1.000
80 (95.2)
1.000
Injury severity score
  Median (IQR) 40 (33–50) 38 (30–45) 0.262 33 (27–42) <0.001
≥26/critical
87 (92.6)
52 (85.3)
0.144
75 (82.4)
0.037
Blood units received 24 h after injury, median (IQR)¶ 31 (21–43) 21 (15–32) 0.003 17 (12–24) <0.001
10–20 18 (19.4) 25 (41.0) 0.003 42 (48.3) <0.001
>20
71 (76.3)
31 (50.8)
0.002
30 (34.5)
<0.001
Traumatic amputation#
64 (68.1)
48 (78.7)
0.150
73 (80.2)
0.060
SOFA score, median (IQR)
  Germany 11 (7–13) 8 (4–13) 0.028 6 (2–9) <0.001
  US hospital
7 (2–11)
4 (1–8)
0.022
1 (0–6)
<0.001
Duration of antifungal use, median (IQR)
24 (14–43)
21 (14–27)
0.006
0
NA
Outcome
  Surgical amputation** 50 (53.2) 26 (42.6) 0.199 24 (26.4) <0.001
  Death 8 (8.5) 1 (1.6) 0.090 0 0.007

*Values are no. (%) except as indicated. Patients with >1 wound with differing classifications are classified at the highest level. One patient with a wound classified as high suspicion died within 24 h of collection of sample providing laboratory evidence of fungal infection, precluding classification as having an IFI. IFI, invasive fungal wound infection; IQR, interquartile range; SOFA, sequential organ failure assessment.
†Compares characteristics between those having an IFI and those having a high-suspicion wound.
‡Compares characteristics between those having an IFI and those having a low-suspicion wound.
§Information about whether patient was on foot patrol or in a vehicle is missing for 17 IFI patients, 7 patients with high-suspicion wounds, and 7 patients with low-suspicion wounds. Percentages and p-values based on total minus missing.
¶Information missing for 1 patient with an IFI and 4 patients with low-suspicion wounds. Percentages and p-values based on total minus missing.
#Includes amputations that occurred before admission to a US hospital.
**Defined as amputation that occurred after admission to a US hospital.

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Page created: August 20, 2019
Page updated: August 20, 2019
Page reviewed: August 20, 2019
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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