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Candida infection in massively burned patients
M H Desai1, D N Herndon, S Abston
1University of Texas Medical Branch Department of Surgery, Galveston.
The Journal of Trauma
|October 1, 1987
Summary
Opportunistic fungal infections, especially Candida septicemia, pose a significant risk for severely burned patients. Early detection and treatment of fungal infections in burn patients can drastically reduce mortality rates.
Area of Science:
- Infectious Diseases
- Burn Care
- Mycology
Background:
- Immunosuppressed patients with severe burns are susceptible to opportunistic fungal infections.
- Antibiotic use for bacterial infections can increase the risk of fungal overgrowth.
- Massive burn excision and grafting have improved outcomes but may increase susceptibility to fungal sepsis.
Purpose of the Study:
- To investigate the incidence and risk factors of fungal infections, particularly Candida septicemia, in severely burned patients.
- To evaluate the impact of burn size, surgical interventions, and antibiotic use on the development of fungal infections.
- To assess the effectiveness of early recognition and treatment strategies for Candida septicemia in burn patients.
Main Methods:
- Retrospective analysis of 393 burn patients admitted to the Shriners Burns Institute.
- Identification of patients with fungal cultures, multi-organ involvement, and Candida septicemia.
- Comparison of burn size (total body surface area) and timing of interventions between patients with and without Candida septicemia.
Main Results:
- 125 patients (31.8%) had fungal cultures positive during hospitalization.
- 42 patients (10.7%) developed multi-organ involvement, with 21 (50%) progressing to Candida septicemia.
- Patients with Candida septicemia had a significantly larger mean third-degree burn size (65% TBSA) compared to those with multi-organ involvement without sepsis (38% TBSA).
- Candida septicemia typically developed within the first week postburn and 7 days after excision therapy.
- Mortality in patients treated with early amphotericin therapy was 14%, compared to 60-90% in other reported series.
Conclusions:
- Massive burns, immunosuppression, extensive surgery, and broad-spectrum antibiotics create a high-risk environment for early Candida septicemia.
- Early recognition of burn wound invasion through biopsies and swabs, coupled with prompt amphotericin therapy, is crucial for reducing mortality.
- Aggressive management of fungal infections in burn patients is essential for improving survival rates.