Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
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)

Main Article

Table 4

Microbiological findings for US military patients who had battlefield trauma wounds with invasive fungal infections and laboratory evidence of fungal infection, June 1, 2009–December 31, 2014*

Culture findings IFI wounds, n = 143 High-suspicion wound, n = 120 p value† Low-suspicion wound, n = 150 p value‡
Fungal cultures not sent
 9 (6.3)
 3 (2.5)
 0.235
 2 (1.3)
 0.032
Fungal growth§
None 21 (14.7) 16 (13.5) 0.774 9 (6.0) 0.014
1 fungus 55 (38.5) 50 (41.7) 0.597 91 (60.7) <0.001
>1 fungi 58 (40.6) 51 (42.5) 0.751 48 (32.0) 0.128
>1 fungi plus bacteria 82 (57.3) 80 (66.7) 0.121 83 (55.3) 0.729
Order Mucorales 55 (38.5) 26 (21.7) 0.003 13 (8.7) <0.001
Aspergillus spp. 45 (31.5) 39 (32.5) 0.858 55 (36.7) 0.348
Fusarium spp. 24 (16.8) 20 (16.7) 0.980 6 (4.0) <0.001
Other filamentous fungi#
 19 (13.3)
 27 (22.7)
 0.046
 69 (45.7)
 <0.001
Bacterial growth§
None 3 (2.1) 1 (0.8) 0.628 3 (2.0) ≈1.00
Staphylococcus aureus** 0 0 NA 2 (1.3) 0.499
Enterococcus spp. 53 (37.1) 51 (42.5) 0.369 42 (28.0) 0.098
E. faecalis 5 (3.5) 5 (4.2) 0.777 8 (5.3) 0.445
E. faecium 41 (28.7) 42 (35.0) 0.271 31 (20.7) 0.111
Escherichia coli 22 (15.4) 20 (16.7) 0.777 23 (15.3) 0.990
Pseudomonas spp. 21 (14.7) 23 (19.2) 0.332 16 (10.7) 0.301
P. aeruginosa 16 (11.2) 14 (11.7) 0.903 11 (7.3) 0.254
Acinetobacter baumannii 29 (20.3) 11 (9.2) 0.012 6 (4.0) <0.001
Other gram-negative bacilli 30 (21.0) 29 (24.2) 0.537 21 (14.0) 0.115
ESKAPE pathogen†† 49 (34.3) 50 (41.7) 0.217 44 (29.3) 0.365
Multidrug resistant‡‡ 53 (37.1) 34 (28.3) 0.134 26 (17.3) <0.001

*Values are no. (%) except as indicated. IFI, invasive fungal infection; NA, not applicable.
†Compares characteristics between IFI and high-suspicion wounds.
‡Compares characteristics between IFI and low-suspicion wounds.
§Because of polymicrobial wounds, organisms are not mutually exclusive and will add to more than the total. Bacterial cultures were restricted to those collected within 14 d of injury.
¶Category of >1 fungi plus bacteria is not mutually exclusive from fungal cultures with 1 fungus or >1 fungi.
#Includes Acrophialophora spp., Alternaria spp., Bipolaris spp., Scedosporium spp., and Trichoderma.
**Includes methicillin-resistant and methicillin-susceptible S. aureus.
††ESKAPE pathogens are Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.
‡‡Multidrug resistant is defined as resistance to ≥3 of 4 antibiotic classes or producion of extended-spectrum β-lactamase or carbapenemases.

Main Article

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.
file_external