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

Area of Science:

• Medical Microbiology
• Infectious Diseases
• Clinical Decision Support

Background:

• Deep wound infections pose significant risks, particularly for invasive fungal infections (IFI).
• Accurate classification is crucial for effective treatment of contaminated wounds in military personnel.
• Distinguishing between IFI and high/low suspicion cases guides antifungal therapy decisions.

Purpose of the Study:

• To evaluate a classification system for managing deep, contaminated wounds at risk for invasive fungal infection (IFI).
• To assess the utility of wound characteristics and fungal identification in guiding clinical decisions.

Main Methods:

• A retrospective study of 246 US service members with 413 contaminated wounds injured in Afghanistan (2009-2014).
• Wounds were classified as IFI, high suspicion, or low suspicion based on necrosis, laboratory evidence, and treatment duration.
• Fungal isolates were identified, with a focus on the order Mucorales.

Main Results:

• 143 wounds classified as IFI, 120 as high suspicion, and 150 as low suspicion.
• IFI patients exhibited more severe injuries and required more blood transfusions.
• Mucorales fungi were more prevalent in IFI (39%) and high-suspicion (21%) wounds compared to low-suspicion wounds (9%).
• Wounds not requiring immediate antifungal therapy lacked necrosis and signs of localized infection, and did not involve Mucorales.

Conclusions:

• The classification system effectively differentiates wound types requiring different management strategies.
• The presence of Mucorales fungi is a significant indicator for invasive fungal infection in deep wounds.
• Clinical decision support systems incorporating wound characteristics and fungal identification can optimize treatment for contaminated wounds.