Invasive Fungal Infection Increases Mortality Risk After Burn Injury

Area of Science:

• Medical Research
• Infectious Diseases
• Burn Care

Background:

• Invasive fungal infections (IFIs) pose a deadly threat to hospitalized patients, particularly those with burn injuries due to compromised immunity.
• There is a rising incidence of non-Candida fungal infections in burn patients.

Purpose of the Study:

• To evaluate the mortality associated with IFIs in burn injury patients.
• To analyze the impact of burn severity (%TBSA) on IFI-related mortality.

Main Methods:

• Utilized a large, multi-institutional electronic health record dataset from US burn centers (2002-2024).
• Included burn patients diagnosed with fungal mycosis and treated with systemic antifungals (IFI cohort).
• Propensity-matched IFI cohort with a control cohort of burn patients without mycoses or antifungal treatment based on gender, age, and %TBSA.

Main Results:

• The 1-year mortality rate for burn patients with IFIs was 18.5%, compared to 1.9% in controls (Risk Ratio: 9.8).
• Mortality risk increased stepwise with burn severity: 21.6% for <10% TBSA, 29.0% for 10%-49% TBSA, and 33.1% for >50% TBSA.
• Aspergillus, invasive Candida, and unspecified mycoses were the most common and deadly fungal infections.

Conclusions:

• Fungal infections are associated with a nearly 10-fold increase in mortality among all burn patients.
• Burn severity significantly impacts IFI-related mortality, with even minor burns (<10% TBSA) carrying a >20% mortality risk.
• Effective antifungal treatment and prevention strategies are crucial for improving outcomes in burn patients at risk for IFIs.