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Choong E, Jurat D, Sandeep B, Rainnie B, Manzanero S, Dowsey M, McPhail S, Choong PF, Wood F. The impact of infection on length of stay in adult burns: A scoping review. Burns 2024; 50:797-807. [PMID: 38307765 DOI: 10.1016/j.burns.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 11/29/2023] [Accepted: 01/10/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND The disruption to the immune system and profound metabolic response to burn injury gives rise to a unique susceptibility to infection. Indeed, infection is one of the most frequently encountered post-burns complications placing significant burden on patients and healthcare system. Advancements in burn care have led to marked improvements in burn-related mortality and morbidity; however, scarce hospital resources hamper adequate burn-related care, and patient length of stay (LOS) in hospital is an important drain on such resources. The aim of this review was to assess and evaluate the existing literature relating to the impact of infections on LOS in hospitalised, adult burn patients. METHODS Electronic searches were performed in Medline and Embase. Eligible studies were those reporting on LOS and infection in adult burn populations. Articles published before 2000 were excluded to ensure that the analysis was focused on contemporary literature that reflects current, clinical management of burn patients. RESULTS Nineteen studies (54,397 burn patients) were included in the review. All studies were retrospective, with the majority undertaken in North America (14 studies). The mean age range was 38-67 years and the majority of patients were male. Inhalation injury was recorded in eleven studies. The most common types of infection included pneumonia, blood stream infections (BSI) and burn wound infections. Overall, there was a trend towards a positive association between infection and LOS. CONCLUSION The results of this scoping review provide an overview of the existing literature on the relationship between infection and LOS in adult burn populations. However, significant gaps remain in knowledge which call for further high-quality research. Standardised definitions for the collection of infection data and the use of burns specific infection control guidelines are also critical to understanding and improving patient outcomes.
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Affiliation(s)
- Emma Choong
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; St Vincent's Hospital Melbourne, Fitzroy 3065, Victoria, Australia; University of Melbourne, Department of Surgery, St. Vincent's Hospital Melbourne, Victoria, Australia.
| | - Danika Jurat
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; State Burns Unit, Fiona Stanley Hospital, Murdoch 6150, Western Australia, Australia
| | - B Sandeep
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; State Burns Unit, Fiona Stanley Hospital, Murdoch 6150, Western Australia, Australia
| | - Briana Rainnie
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; Royal Brisbane and Women's Hospital, Herston 4029, Queensland, Australia
| | - Silvia Manzanero
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; Jamieson Trauma Institute, Metro North Health, Butterfield Street, Herston, Brisbane, QLD 4029, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Michelle Dowsey
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; University of Melbourne, Department of Surgery, St. Vincent's Hospital Melbourne, Victoria, Australia
| | - Steven McPhail
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove 4059, Queensland, Australia; Digital Health and Informatics Directorate, Metro South Health, Woolloongabba 4102, Queensland, Australia
| | - Peter Fm Choong
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; University of Melbourne, Department of Surgery, St. Vincent's Hospital Melbourne, Victoria, Australia
| | - Fiona Wood
- Infection Collaboration in trAuma, orthopaedics and burns (ICARAUS), Australia; State Burns Unit, Fiona Stanley Hospital, Murdoch 6150, Western Australia, Australia
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Ji S, Xiao S, Xia Z. Consensus on the treatment of second-degree burn wounds (2024 edition). BURNS & TRAUMA 2024; 12:tkad061. [PMID: 38343901 PMCID: PMC10858447 DOI: 10.1093/burnst/tkad061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/29/2023] [Accepted: 12/08/2023] [Indexed: 02/21/2024]
Abstract
Second-degree burns are the most common type of burn in clinical practice and hard to manage. Their treatment requires not only a consideration of the different outcomes that may arise from the dressing changes or surgical therapies themselves but also an evaluation of factors such as the burn site, patient age and burn area. Meanwhile, special attention should be given to the fact that there is no unified standard or specification for the diagnosis, classification, surgical procedure, and infection diagnosis and grading of second-degree burn wounds. This not only poses great challenges to the formulation of clinical treatment plans but also significantly affects the consistency of clinical studies. Moreover, currently, there are relatively few guidelines or expert consensus for the management of second-degree burn wounds, and no comprehensive and systematic guidelines or specifications for the treatment of second-degree burns have been formed. Therefore, we developed the Consensus on the Treatment of Second-Degree Burn Wounds (2024 edition), based on evidence-based medicine and expert opinion. This consensus provides specific recommendations on prehospital first aid, nonsurgical treatment, surgical treatment and infection treatment for second-degree burns. The current consensus generated a total of 58 recommendations, aiming to form a standardized clinical treatment plan.
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Affiliation(s)
- Shizhao Ji
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
| | - Shichu Xiao
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
| | - Zhaofan Xia
- Correspondence: Shizhao Ji, ; Shichu Xiao, ; Zhaofan Xia,
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3
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Gil J, Solis M, Higa A, Davis SC. Candida albicans Infections: a novel porcine wound model to evaluate treatment efficacy. BMC Microbiol 2022; 22:45. [PMID: 35120444 PMCID: PMC8815218 DOI: 10.1186/s12866-022-02460-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 01/24/2022] [Indexed: 11/15/2022] Open
Abstract
Candida albicans is a common cause of opportunistic mycoses worldwide and a major contributor in wound infections. The purpose of this study was to establish a fungal wound model and analyze the effects of a common antifungal agent against the proliferation of three C. albicans strains. Second degree burns were created, and then inoculated with one of three different C. albicans ATCC strains: 10261 reference strain, 64550 fluconazole resistant and 26310 fluconazole sensitive. After fungal inoculation, every wound was covered with dressings for 4 h to allow fungal colonization on every wound bed. After 4 h, the dressings were removed, and each wound was treated either once or twice daily with a topical terbinafine hydrochloride or left untreated. On days 2, 4 and 7 post inoculation, three wounds from each treatment group were scrub cultured and quantified. On day 2, wounds infected with the sensitive strains 26310 and 10261 and treated twice showed a significant reduction when compared against those infected wounds receiving once daily treatment. On day 4, wounds which were infected with C. albicans fluconazole sensitive (ATCC 26310) showed a significant reduction in fungal cell counts with treatment applied twice daily. A significant reduction in the colony counts was exhibited in all three strains at the seventh day with active as compared to the non-treated wounds. Twice daily treatment resulted in a lower fungal count than once daily treatment. Neither treatment was able to entirely eradicate C. albicans during the duration of this study. Establishing a reliable fungal wound model will help in the translational goal of identifying new antifungal that could be used clinically by wound care providers.
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Affiliation(s)
- Joel Gil
- Miller School of Medicine, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery Wound Healing Research Laboratory Miami, University of Miami, Miami, 33136, FL, United States.
| | - Michael Solis
- Miller School of Medicine, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery Wound Healing Research Laboratory Miami, University of Miami, Miami, 33136, FL, United States
| | - Alexander Higa
- Miller School of Medicine, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery Wound Healing Research Laboratory Miami, University of Miami, Miami, 33136, FL, United States
| | - Stephen C Davis
- Miller School of Medicine, Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery Wound Healing Research Laboratory Miami, University of Miami, Miami, 33136, FL, United States
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4
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Species Distribution and Antifungal Susceptibility Pattern of Candida Recovered from Intensive Care Unit Patients, Vietnam National Hospital of Burn (2017-2019). Mycopathologia 2021; 186:543-551. [PMID: 34118027 DOI: 10.1007/s11046-021-00569-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 05/30/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Candida species is the most common cause of invasive fungal infection. With the wide variation in species distribution and antifungal susceptibility of causative agents, local epidemiological profiles are needed to provide effective guidelines for the treatment of invasive candidiasis. OBJECTIVE To find out the species distribution and antifungal susceptibilities of Candida strains isolated from patients in an intensive care unit (ICU) of Vietnam. METHODS All patients in ICU of Vietnam National Hospital of Burn with Candida isolation reported from January 2017 to December 2019 were retrospectively studied. Species identification and antifungal susceptibility testing were performed using VITEK 2 Compact. The identification was reconfirmed by sequencing of the internal transcribed spacer regions when needed. RESULTS A total of 186 yeasts belonging to ten species were collected. The most common agent was C. tropicalis (45.7%), followed by C. albicans (42.4%), and C. parapsilosis (7.53%). The isolated yeasts showed less susceptibility to fluconazole (resistant rate R 10.7%) than to micafungin, caspofungin, flucytosine and amphotericin B (R 0%, 0.6%, 2.3% and 3.4%, respectively, p < 0.05). C. albicans isolates were more susceptible to fluconazole (R 5.2%) than C. tropicalis (R 15.7%). Resistance to voriconazole was seen only among C. albicans (3.9%) and C. tropicalis isolates (9.9%). CONCLUSION Non-albicans species (especially C. tropicalis) is the predominant species, and there is a significant proportion of isolates with reduced susceptibility to azole but not to echinocandin.
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Van Bang BN, Thanh Xuan N, Xuan Quang D, Ba Loi C, Thai Ngoc Minh N, Nhu Lam N, Ngoc Anh D, Thi Thu Hien T, Xuan Su H, Tran-Anh L. Prevalence, species distribution, and risk factors of fungal colonization and infection in patients at a burn intensive care unit in Vietnam. Curr Med Mycol 2021; 6:42-49. [PMID: 33834142 PMCID: PMC8018815 DOI: 10.18502/cmm.6.3.4664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background and Purpose : Burn patients are at a higher risk of infections caused by different organisms. This study aimed to address the prevalence, causative species, and factors related to fungal colonization or infection in patients with acute severe injuries admitted to the intensive care unit (ICU) of a burn hospital in northern Vietnam. Materials and Methods: This prospective study was conducted on 400 patients in a burn ICU between 2017 and 2019. Clinical samples were weekly collected and screened for fungi, and relevant clinical information was obtained from medical records. Results: According to the results, 90% of the patients were colonized with fungi. Out of this group, 12.75% of the cases had
invasive fungal infection (IFI). Eleven yeasts and six mold species were isolated from the patients, with the most
common species being Candida tropicalis (45.56%) and C. albicans (41.94%). Among the eleven species causing
fungal wound infection (FWI), the most common agents were Candida (66.7% of FWI patients) and Aspergillus (38.5%) species.
Three Candida species isolated from blood were C. tropicalis (66.7%), C. albicans (20.0%),
and C. parapsilosis (14.3%). No factors were found to expose the patients to a higher risk of fungal colonization.
However, hyperglycemia, prolonged ICU stay, and heavy Candida species colonization were found to be independently predictive of IFI. Conclusion: Burn patients are at the risk of fungal infection with Candida species (especially C. tropicalis)
and Aspergillus as the most frequently responsible agents. Continuous surveillance of fungi and appropriate management
of pathophysiological consequences are essential to prevent fungal infection in burn patients.
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Affiliation(s)
- Be Nguyen Van Bang
- Department of Hamatology, Toxicology, Radiation, and Occupational Diseases, Military Hospital 103, Vietnam Military Medical University, Ha Dong, Ha Noi, Vietnam
| | - Nguyen Thanh Xuan
- Department of Medical Education, Military Hospital 103, Vietnam Military Medical University, Ha Dong, Ha Noi, Vietnam
| | - Dinh Xuan Quang
- Department of Scientific and Training Management, National Institute of Malaria, Parasitology, and Entomology, Nam Tu Liem, Ha Noi, Vietnam
| | - Cao Ba Loi
- Department of Scientific and Training Management, National Institute of Malaria, Parasitology, and Entomology, Nam Tu Liem, Ha Noi, Vietnam
| | - Nguyen Thai Ngoc Minh
- Intensive Care Unit, National Hospital of Burn, Vietnam Military Medical University, Ha Dong, Ha Noi, Vietnam
| | - Nguyen Nhu Lam
- Intensive Care Unit, National Hospital of Burn, Vietnam Military Medical University, Ha Dong, Ha Noi, Vietnam
| | - Do Ngoc Anh
- Department of Parasitology, Vietnam Military Medical University, Ha Dong, Ha Noi, Vietnam
| | - Truong Thi Thu Hien
- Department of Microbiology, National Hospital of Burn, Vietnam Military Medical University, Ha Dong, Ha Noi, Vietnam
| | - Hoang Xuan Su
- Department of Microbiology and Pathogens, Institute of Biomedicine and Pharmacy, National Hospital of Burn, Vietnam Military Medical University, Ha Dong, Ha Noi, Vietnam These authors contributed equally to this work and acted as joint first authors
| | - Le Tran-Anh
- Department of Parasitology, Vietnam Military Medical University, Ha Dong, Ha Noi, Vietnam
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Sobouti B, Dahmardehei M, Fallah S, Karrobi M, Ghavami Y, Vaghardoost R. Candidemia in pediatric burn patients: Risk factors and outcomes in a retrospective cohort study. Curr Med Mycol 2020; 6:33-41. [PMID: 33834141 PMCID: PMC8018818 DOI: 10.18502/cmm.6.3.4663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background and Purpose : Despite advances in burn care and management, infections are still a major contributor to morbidity and mortality rates in patients with burn injuries. Regarding this, the present study was conducted to investigate the prevalence and importance of candidemia in pediatric burn patients. Materials and Methods: Blood samples were collected from the patients and cultured in an automated blood culture system. Candida species were identified using specific culture media. The relationship between candidemia and possible risk factors was evaluated and compared to a control group. Results: A total of 71 patients with the mean age of 4.52±3.63 years were included in the study. Blood cultures showed candidemia in 19 (27%) patients. Based on the results,
C. albicans was the most common fungus among patients with and without candidemia. The results of statistical analysis also showed that
candidemia was significantly correlated with total body surface area (TBSA), mechanical ventilation, duration of total parenteral
nutrition, length of intensive care unit (ICU) stay, presence of neutropenia, and R-Baux score (all P≤0.001). In this regard, TBSA, length of ICU stay, R-Baux score, and Candida score were identified as the determinant factors for mortality due to candidemia. Conclusion: Candidemia increases the mortality and morbidity rates associated with burn injuries. Prompt diagnostic and prevention measures can reduce the unfortunate outcomes via controlling the possible risk factors.
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Affiliation(s)
- Behnam Sobouti
- Department of Pediatrics, Ali-Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Dahmardehei
- Department of Plastic Surgery, Burn Research Center, Motahari Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Fallah
- Mofid Children Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Karrobi
- Department of Pediatrics, Ali-Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Yaser Ghavami
- Department of Plastic Surgery, Burn Research Center, Motahari Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Reza Vaghardoost
- Department of Plastic Surgery, Burn Research Center, Motahari Hospital, Iran University of Medical Sciences, Tehran, Iran
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7
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Maurel V, Denis B, Camby M, Jeanne M, Cornesse A, Glavnik B, Alanio A, Rousseau AF, Lefloch R, Lagrange-Xelot M, Textoris J, Wiramus S, de Tymowski C, Legrand M. Outcome and characteristics of invasive fungal infections in critically ill burn patients: A multicenter retrospective study. Mycoses 2020; 63:535-542. [PMID: 32077536 DOI: 10.1111/myc.13068] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 02/16/2020] [Accepted: 02/18/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Characteristics and outcome of invasive fungal infection (IFI) in critically ill burn patients have been poorly explored. OBJECTIVES We report the factors associated with 90-day mortality in a multicentre retrospective European study. PATIENTS/METHODS All burn patients with confirmed IFI admitted between 1 January 2010 to 31 December 2015 in 10 centres in France and Belgium were included. RESULTS Ninety-four patients were enrolled with 110 cases of IFIs: 79 (71.8%) were yeasts IFI and 31 (28.2%) filamentous IFI. Incidence was 1% among admitted patients. The 90-day mortality was 37.2% for all IFIs combined, 52% for filamentous infection and 31.9% for yeast infection. Patients with more than one IFI had a higher 90-day mortality than patients with only one episode (61.5% vs 33.5% (P = .006)). In multivariate analysis, higher Simplified Acute Physiology Score II (OR = 1.05 (95% CI: 1.02-1.09) P = .003), bacterial co-infection (OR = 3.85 (95% CI: 1.23-12.01), P = .014) and use of skin allografts at the time of IFI diagnosis (OR = 3.87 (95% CI: 1.31-11.42), P = .021) were associated with 90-day mortality. CONCLUSIONS Although rare, invasive fungal infections remain associated with poor outcome in burn patients. Bacterial co-infection and presence of allograft were potentially modifiable factors independently associated with outcome.
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Affiliation(s)
- Véronique Maurel
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, St-Louis Hospital, Paris, France
| | - Blandine Denis
- Department of Infectious Diseases, AP-HP, St-Louis Hospital, Paris, France
| | - Matthieu Camby
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, St-Louis Hospital, Paris, France
| | - Mathieu Jeanne
- Department of Anesthesiology and Intensive Care, CHU Lille, Lille, France
| | - Aline Cornesse
- Department of Anesthesiology and Critical Care and Burn Unit, CHU Toulouse, Toulouse, France
| | - Boris Glavnik
- Department of Anesthesiology and Critical Care and Burn Unit, Mercy Hospital, Metz, France
| | - Alexandre Alanio
- Molecular Mycology Unit, Institut Pasteur, CNRS, UMR2000, Paris, France.,Laboratoire de Parasitologie-Mycologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France.,Sorbonne Paris Cité, Université Paris Diderot, Paris, France
| | | | - Ronan Lefloch
- Burn Intensive Care Unit, CHU Nantes, Nantes, France
| | | | - Julien Textoris
- Department of Anesthesiology and Intensive Care, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France.,EA7426 P13 "Pathophysiology of Injury-Induced Immunosuppression", Hospices Civils de Lyon, bioMérieux, Université Claude Bernard Lyon-1, Lyon, France
| | - Sandrine Wiramus
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HM, Conception Hospital, Marseille, France
| | - Christian de Tymowski
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, St-Louis Hospital, Paris, France
| | - Matthieu Legrand
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, St-Louis Hospital, Paris, France.,Sorbonne Paris Cité, Université Paris Diderot, Paris, France.,UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), F-CRIN INI-CRCT Network, Paris, France
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8
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Abstract
Abstract
The purpose of this review is to summarize the current knowledge acquired during preclinical and clinical studies regarding topically used herbal products with burn wound-healing activity. Moreover, antimicrobial, anti-inflammatory, and antioxidant mechanisms of their action as well as adverse effects of herbal therapy will be also described.
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Affiliation(s)
- Anna Herman
- Faculty of Health Sciences, Warsaw School of Engineering and Health, Warsaw, Poland
| | - Andrzej P Herman
- Department of Genetic Engineering, The Kielanowski Institute of Animal Physiology and Nutrition, Polish Academy of Sciences, Jabłonna near Warsaw, Poland
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9
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Zhou J, Tan J, Gong Y, Li N, Luo G. Candidemia in major burn patients and its possible risk factors: A 6-year period retrospective study at a burn ICU. Burns 2019; 45:1164-1171. [PMID: 30686692 DOI: 10.1016/j.burns.2019.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 12/26/2018] [Accepted: 01/03/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The aims of this study were to evaluate the epidemiological and clinical characteristics of candidemia in a typical burn ICU, and to determine the risk factors associated with candidemia among major burn patients. METHOD This retrospective observational study of candidemia from 2012 to 2017 in a burn ICU was conducted in the Department of Burn, Southwest hospital, Chongqing, China. RESULTS The study included 410 major burn patients (≥40% total body surface area), 39 (9.51%) of which were diagnosed with candidemia. The annual incidences of candidemia varied from 6.06% to 17.54%, and increased gradually in the 6 years. Candida parapsilosis was the dominant pathogen (28.21% strains). The overall resistance rate of Candida spp. to fluconazole was 35.89%. Candidemia cases most frequently occurred in the 2nd (30.77%) and 3rd (23.08%) weeks after burn, and intravascular catheters were the most common sources of bloodstream Candida infections (31.58%). The crude mortality of candidemia was 23.08%, and the mortality attributable to candidemia was 14.99%. Risk factors of candidemia included inhalation injury, renal dysfunction with replacement therapy, severe gastrointestinal complications, T-cell lymphopenia and prior Candida colonization. CONCLUSION Candidemia has a high incidence and mortality in major burn patients. The changes in etiology and drug sensitivity may make new challenges for the management of candidemia in burn ICUs.
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Affiliation(s)
- Junyi Zhou
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
| | - Jianglin Tan
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
| | - Yali Gong
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
| | - Ning Li
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China
| | - Gaoxing Luo
- State Key Laboratory of Trauma, Burn and Combined Injury, Institute of Burn Research, Southwest Hospital, the Third Military Medical University, Chongqing 400038, China.
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10
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Dudoignon E, Alanio A, Anstey J, Depret F, Coutrot M, Fratani A, Jully M, Cupaciu A, Chaussard M, Oueslati H, Ferry A, Benyamina M, de Tymowski C, Boccara D, Serror K, Chaouat M, Mimoun M, Lafaurie M, Denis B, Gits-Muselli M, Bretagne S, Mebazaa A, Legrand M, Soussi S. Outcome and potentially modifiable risk factors for candidemia in critically ill burns patients: A matched cohort study. Mycoses 2018; 62:237-246. [PMID: 30478963 DOI: 10.1111/myc.12872] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 10/26/2018] [Accepted: 11/20/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patients with extensive burns are at risk of developing candidemia. OBJECTIVES To identify potentially modifiable risk factors and outcomes of candidemia in critically ill burns patients. PATIENTS AND METHODS Retrospective matched cohort study including adult burns patients. Patients who developed candidemia were matched with burns patients with Candida spp colonisation and sepsis or septic shock without candidemia in a ratio of 1:3 (same severity scores and colonisation index). Univariate and multiple regression analyses were performed. RESULTS Of 130 severely burned patients with Candida spp colonisation and at least one episode of sepsis or septic shock, 14 were diagnosed with candidemia. In the candidemia group, patients had a median (IQR) total burns surface area (TBSA) of 57 (38-68)%, SAPSII of 43 (36-58) and ABSI of 11 (8-13). Multiple regression analysis showed that only duration of prior antibiotic therapy was independently associated with candidemia. ICU mortality was higher in the candidemia group (71% vs 35% [P = 0.02]). The log-rank test for 28-day mortality comparing patients with candidemia treated with an empirical strategy vs a curative strategy did not reach significance (P = 0.056). CONCLUSIONS Burns patients having received recent antibiotherapy have a higher risk of candidemia. Antifungal strategies did not influence outcome in this series.
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Affiliation(s)
- Emmanuel Dudoignon
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Alexandre Alanio
- Parasitology and Mycology laboratory, AP-HP, Hôpital Saint-Louis, Paris, France.,Université Paris Diderot, Paris, France.,Molecular mycology unit, Institut Pasteur, CNRS, UMR2000, Paris, France
| | - James Anstey
- Intensive Care Unit, Royal Melbourne Hospital, Parkville, Melbourne, Australia
| | - François Depret
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France.,Université Paris Diderot, Paris, France
| | - Maxime Coutrot
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France.,Université Paris Diderot, Paris, France
| | - Alexandre Fratani
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Marion Jully
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Alexandru Cupaciu
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Maïté Chaussard
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Haikel Oueslati
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Axelle Ferry
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Mourad Benyamina
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Christian de Tymowski
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - David Boccara
- Plastic Surgery and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Kevin Serror
- Plastic Surgery and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Marc Chaouat
- Plastic Surgery and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Maurice Mimoun
- Plastic Surgery and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Matthieu Lafaurie
- Department of Infectious Diseases, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Blandine Denis
- Department of Infectious Diseases, AP-HP, Hôpital Saint-Louis, Paris, France
| | - Maud Gits-Muselli
- Parasitology and Mycology laboratory, AP-HP, Hôpital Saint-Louis, Paris, France.,Université Paris Diderot, Paris, France.,Molecular mycology unit, Institut Pasteur, CNRS, UMR2000, Paris, France
| | - Stephane Bretagne
- Parasitology and Mycology laboratory, AP-HP, Hôpital Saint-Louis, Paris, France.,Université Paris Diderot, Paris, France.,Molecular mycology unit, Institut Pasteur, CNRS, UMR2000, Paris, France
| | - Alexandre Mebazaa
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France.,Université Paris Diderot, Paris, France.,Institut National de la Santé et de la Recherche Médicale (INSERM), UMR INSERM 942, Hôpital Lariboisière, F-CRIN INI-CRCT network, Univ Paris Diderot, Paris, France
| | - Matthieu Legrand
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France.,Université Paris Diderot, Paris, France.,Institut National de la Santé et de la Recherche Médicale (INSERM), UMR INSERM 942, Hôpital Lariboisière, F-CRIN INI-CRCT network, Univ Paris Diderot, Paris, France
| | - Sabri Soussi
- Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Hôpital Saint-Louis, Paris, France
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11
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Fan C, Tian Q, Huang G, Zhang L, Wu Q, Zhang K. Candida tropicalis burn wound sepsis: A series of histopathology-confirmed cases. Intensive Crit Care Nurs 2018; 46:6-9. [DOI: 10.1016/j.iccn.2018.01.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Revised: 01/10/2018] [Accepted: 01/12/2018] [Indexed: 12/26/2022]
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12
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Maura D, Bandyopadhaya A, Rahme LG. Animal Models for Pseudomonas aeruginosa Quorum Sensing Studies. Methods Mol Biol 2018; 1673:227-241. [PMID: 29130177 DOI: 10.1007/978-1-4939-7309-5_18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Quorum sensing (QS) systems play global regulatory roles in bacterial virulence. They synchronize the expression of multiple virulence factors and they control and modulate bacterial antibiotic tolerance systems and host defense mechanisms. Therefore, it is important to obtain knowledge about QS modes of action and to test putative therapeutics that may interrupt QS actions in the context of infections. This chapter describes methods to study bacterial pathogenesis in murine acute and persistent/relapsing infection models, using the Gram-negative bacterial pathogen Pseudomonas aeruginosa as an example. These infection models can be used to probe bacterial virulence functions and in mechanistic studies, as well as for the assessment of the therapeutic potential of antibacterials, including anti-virulence agents.
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Affiliation(s)
- Damien Maura
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA, USA.,Shriners Hospitals for Children Boston, Boston, MA, USA
| | - Arunava Bandyopadhaya
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA, USA.,Shriners Hospitals for Children Boston, Boston, MA, USA
| | - Laurence G Rahme
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. .,Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA, USA. .,Shriners Hospitals for Children Boston, Boston, MA, USA.
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13
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Sharma S, Bajaj D, Sharma P. Fungal Infection in Thermal Burns: A Prospective Study in a Tertiary Care Centre. J Clin Diagn Res 2016; 10:PC05-PC07. [PMID: 27790507 DOI: 10.7860/jcdr/2016/20336.8445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 06/17/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Burn Wound Infection (BWI) is primarily caused by aerobic bacteria followed by fungi, anaerobes and viruses. There has been a worldwide decrease in incidence of bacterial infections in burns due to better patient care and availability of effective antibiotics. Consequently, the fungal burn wound infection has shown an increasing trend. AIM The aim of study was to assess the frequency of fungal infections in thermal burn wounds with respect to age of wounds, total body surface involved, depth of burns and to assess common fungal pathogens. MATERIALS AND METHODS The study was conducted on 50 patients admitted with thermal burn wounds having 20-60% burns in the surgical unit. Pus swab and scrapings were taken under local anaesthesia from each burn patient. Scrapings were put in a sterile container and sent to Mycology section of Microbiology department and were examined by direct microscopy and culture studies on Sabouraud's Dextrose Agar medium in the Mycology section of Microbiology department. RESULTS In our study, the incidence of fungal infection in burn wound patients came out to be 26%. The incidence of fungal infection increased with increase in Total Body Surface Area, (TBSA) increase in depth and age of burn. In our study, the maximum positive fungal cultures were seen in the third week of post-burn period. No positive culture was seen in the first week and 30.76% positive fugal cultures were seen in second post-burn week. Candida albicans was found to be the most common organism followed by Non-albicans Candida and Aspergillus. CONCLUSION It was concluded from the study that incidence of fungal infections in thermal burns increased with increase in post-burn period and with increasing depth and TBSA of burns. Candida albicans was found to be the most common fungus.
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Affiliation(s)
- Sanjeev Sharma
- Associate Professor, Department of Surgery, Government Medical College , Amritsar, Punjab, India
| | - Deepak Bajaj
- Junior Resident, Department of Surgery, Government Medical College , Amritsar, Punjab, India
| | - Pritika Sharma
- Student, Government Medical College , Amritsar, Punjab, India
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14
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Renau AI, García-Vidal C, Salavert M. Enfermedades invasivas por hongos levaduriformes en pacientes quemados graves. Rev Iberoam Micol 2016; 33:160-9. [DOI: 10.1016/j.riam.2016.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 02/10/2016] [Indexed: 10/21/2022] Open
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15
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Fransén J, Huss FRM, Nilsson LE, Rydell U, Sjöberg F, Hanberger H. Surveillance of antibiotic susceptibility in a Swedish Burn Center 1994-2012. Burns 2016; 42:1295-303. [PMID: 27241732 DOI: 10.1016/j.burns.2016.01.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 01/21/2016] [Accepted: 01/22/2016] [Indexed: 11/28/2022]
Abstract
UNLABELLED Patients with burn trauma are at risk for infections caused by antibiotic resistant bacteria (ABR) with subsequent increase in morbidity and mortality. As part of the Swedish strategic program against antibiotic resistance in intensive care (ICU-Strama), we have surveyed the distribution of species and ABR in isolates from patients admitted to a Swedish burn center at Linköping University Hospital from 1994 through 2012. In an international comparison Strama has been successful in reducing the antibiotic consumption among animals and humans in primary care. The aim of this study was to investigate the antibiotic consumption pressure and resistance rates in a Swedish burn unit. METHODS Microbiology data, total body surface area (TBSA), patient days, and mortality were collected from a hospital database for all patients admitted to the Burn Center at the University Hospital of Linköping from April 1994 through December 2012. RESULTS A total of 1570 patients were admitted with a mean annual admission rate of 83 patients (range: 57-152). 15,006 microbiology cultures (approximately 10 per patient) were collected during the study period and of these 4531 were positive (approximately 3 per patient). The annual mean total body surface area (TBSA) was 13.4% (range 9.5-18.5) with an annual mortality rate of 5.4% (range 1-8%). The MRSA incidence was 1.7% (15/866) which corresponds to an MRSA incidence of 0.34/1000 admission days (TAD). Corresponding figures were for Escherichia coli resistant to 3(rd) generation cephalosporins (ESBL phenotype) 8% (13/170) and 0.3/TAD, Klebsiella spp. ESBL phenotype 5% (6/134) and 0.14/TAD, carbapenem resistant Pseudomonas aeruginosa 26% (56/209) and 1.28/TAD, and carbapenem resistant Acinetobacter spp. 3% (2/64) and 0.04/TAD. CONCLUSIONS Our results show a sustained low risk for MRSA and high, although not increasing, risk for carbapenem resistant P. aeruginosa.
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Affiliation(s)
- Jian Fransén
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden.
| | - Fredrik R M Huss
- Department of Surgical Sciences, Plastic Surgery, Uppsala University, Uppsala, Sweden; Department of Plastic- and Maxillofacial Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Lennart E Nilsson
- Department of Clinical and Experimental Medicine, Clinical Microbiology, Linköping University, Linköping, Sweden
| | - Ulf Rydell
- Institution of Clinical and Experimental Medicine, Infectious Diseases, Linköping University, Linköping, Sweden
| | - Folke Sjöberg
- Institution of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Håkan Hanberger
- Institution of Clinical and Experimental Medicine, Infectious Diseases, Linköping University, Linköping, Sweden
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16
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Renau Escrig AI, Salavert M, Vivó C, Cantón E, Pérez Del Caz MD, Pemán J. Candidemia in major burns patients. Mycoses 2016; 59:391-8. [PMID: 26931414 DOI: 10.1111/myc.12488] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 12/06/2015] [Accepted: 02/02/2016] [Indexed: 11/28/2022]
Abstract
Major burn patients have characteristics that make them especially susceptible to candidemia, but few studies focused on this have been published. The objectives were to evaluate the epidemiological, microbiological and clinical aspects of candidemia in major burn patients, determining factors associated with a poorer prognosis and mortality. We conducted a retrospective observational study of candidemia between 1996 and 2012 in major burn patients admitted to the La Fe University Hospital, Valencia, Spain. The study included 36 episodes of candidemia in the same number of patients, 55.6% men, mean age 37.33 years and low associated comorbidity. The incidence of candidemia varied between 0.26 and 6.09 episodes/1000 days stay in the different years studied. Candida albicans was the most common species (61.1%) followed by Candida parapsilosis (27.8%). Candidemia by C. krusei, C. glabrata or C. tropicalis were all identified after 2004. Central vascular catheter (CVC) was established as a potential source of candidemia in 36.1%, followed by skin and soft tissues of thermal injury (22.2%) and urinary tract (8.3%). Fluconazole was used in 19 patients (52.7%) and its in vitro resistance rate was 13.9%. The overall mortality was 47.2%, and mortality related to candidemia was 30.6%. Factors associated with increased mortality were those related to severe infection and shock. CVC was the most usual focus of candidemia. Fluconazole was the most common antifungal drug administered. The management of candidemia in major burn patients is still a challenge.
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Affiliation(s)
- Ana I Renau Escrig
- Internal Medicine Department (Medical Clinic Area), La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Miguel Salavert
- Infectious Diseases Unit (Medical Clinic Area), La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Carmen Vivó
- Major Burns Unit, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - Emilia Cantón
- Experimental Microbiology Unit, Research Centre, La Fe University and Polytechnic Hospital, Valencia, Spain
| | | | - Javier Pemán
- Mycology Unit, Microbiology Department, La Fe University and Polytechnic Hospital, Valencia, Spain
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17
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Lotfi N, Shokohi T, Nouranibaladezaei SZ, Nasrolahi Omran A, Kondori N. High Recovery Rate of Non-albicans Candida Species Isolated From Burn Patients With Candidemia in Iran. Jundishapur J Microbiol 2015; 8:e22929. [PMID: 26587207 PMCID: PMC4644265 DOI: 10.5812/jjm.22929] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 01/29/2015] [Accepted: 02/24/2015] [Indexed: 12/21/2022] Open
Abstract
Background: Blood stream infections (BSIs) are major causes of morbidity and mortality in burn patients. Microorganisms responsible for BSI are generally bacteria; however, Candida spp. are the infection agents in as many as 8% of all cases. Burn wound colonization and infections are generally the first steps to systemic infection. Candidemia in burn patients has been associated with high mortality and a prolonged hospital stay. Objectives: Candidemia in burn patients has been defined as a preterminal event, leading to high morbidity and mortality rates among these patients. The aim of this study was to establish the incidence of candidemia in burn patients in Iran. Patients and Methods: We consecutively collected 405 blood samples from 113 burn patients. The yeast isolates were identified to the species level using conventional procedures. In vitro antifungal susceptibility of the Candida isolates to amphotericin B, fluconazole, voriconazole and caspofungin was performed using the Etest. Results: Twenty-seven samples (6.7%) of the blood cultures from 13 patients (12%) were positive for Candida species. Candidaparapsilosis (38%) and C. tropicalis (38%) were the most commonly found Candida species, followed by C. albicans (15%) and C. guilliermondii (15%) in the patients. The incidence of candidemia was significantly correlated with increased duration of hospitalization, increased time of stay in the intensive care unit, and higher mortality. The antifungal susceptibility tests demonstrated that amphotericin B and voriconazole had the lowest minimum inhibitory concentrations (MICs) against Candida spp. Conclusions: Non-albicans Candida should be considered as significant pathogens in burned patients with candidemia.
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Affiliation(s)
- Nazanin Lotfi
- Department of Medical Mycology, Faculty of Medical Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, IR Iran
- Department of Medical Mycology and Parasitology, Invasive Fungi Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
| | - Tahereh Shokohi
- Department of Medical Mycology and Parasitology, Invasive Fungi Research Center, School of Medicine, Mazandaran University of Medical Sciences, Sari, IR Iran
- Corresponding author: Tahereh Shokohi, Department of Medical Mycology and Parasitology, Invasive Fungi Research Center, School of Medicine, Mazandaran University of Medical Sciences, P. O. Box: 48175-1665, Sari, IR Iran. Tel/Fax: +98-1133543781, E-mail:
| | | | - Ayatollah Nasrolahi Omran
- Department of Medical Mycology, Faculty of Medical Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, IR Iran
| | - Nahid Kondori
- Department of Infectious Disease, University of Gothenburg, Gothenburg, Sweden
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18
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Green silver nanoparticles of Phyllanthus amarus: as an antibacterial agent against multi drug resistant clinical isolates of Pseudomonas aeruginosa. J Nanobiotechnology 2014; 12:40. [PMID: 25271044 PMCID: PMC4189661 DOI: 10.1186/s12951-014-0040-x] [Citation(s) in RCA: 90] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Accepted: 09/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pseudomonas aeruginosa infection is a leading cause of morbidity and mortality in burn and immune-compromised patients. In recent studies, researchers have drawn their attention towards ecofriendly synthesis of nanoparticles and their activity against multidrug resistant microbes. In this study, silver nanoparticles were synthesized from aqueous extract of Phyllanthus amarus. The synthesized nanoparticles were explored as a potent source of nanomedicine against MDR burn isolates of P. aeruginosa. RESULTS Silver nanoparticles were successfully synthesized using P. amarus extract and the nature of synthesized nanoparticles was analyzed by UV-Vis spectroscopy, transmission electron microscopy, energy dispersive X-ray spectroscopy, dynamic light scattering, zeta potential, X- ray diffraction and fourier transform infra-red spectroscopy. The average size of synthesized nanoparticles was 15.7, 24 ± 8 and 29.78 nm by XRD, TEM and DLS respectively. The antibacterial activity of AgNPs was investigated against fifteen MDR strains of P. aeruginosa tested at different concentration. The zone of inhibition was measured in the range of 10 ± 0.53 to 21 ± 0.11mm with silver nanoparticles concentration of 12.5 to 100 μg/ml. The zone of inhibition increased with increase in the concentration of silver nanoparticles. The MIC values of synthesized silver nanoparticles were found in the range of 6.25 to12.5 μg/ml. The MIC values are comparable to the standard antibiotics. CONCLUSION The present study suggests that silver nanoparticles from P. amarus extract exhibited excellent antibacterial potential against multidrug resistant strains of P. aeruginosa from burn patients and gives insight of their potential applicability as an alternative antibacterial in the health care system to reduce the burden of multidrug resistance.
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Luo G, Tan J, Peng Y, Wu J, Huang Y, Peng D, Wang X, Hu D, Xie S, Zhang G, Han C, Huang X, Jia C, Chai J, Huan J, Guo G, Zhan J, Xie W, Cen Y, Yu R, Chen H, Niu X, Wang Y, Fu J, Xue B. Guideline for diagnosis, prophylaxis and treatment of invasive fungal infection post burn injury in China 2013. BURNS & TRAUMA 2014; 2:45-52. [PMID: 27602362 PMCID: PMC5012031 DOI: 10.4103/2321-3868.130182] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 11/04/2013] [Indexed: 02/05/2023]
Abstract
Invasive fungal infection is one of the major complication of severe burns which can induce local or systemic inflammatory response and cause serious substantial damage to the patient. The incidence of fungal infection for burn victims is increasing dramatically during recent years. This guideline, organized by Chinese Society of Burn Surgeons, aims to standardize the diagnosis, prevention and treatment of burn invasive fungal infection. It can be used as one of the tools for treatment of major burn patients.
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Affiliation(s)
- Gaoxing Luo
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Jianglin Tan
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Yizhi Peng
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Jun Wu
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Yuesheng Huang
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Daizhi Peng
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Xu Wang
- State Key Laboratory of Trauma, Burns and Combined Injury, Institute of Burn Research, Southwest Hospital, The Third Military Medical University, Chongqing, 400038 China
| | - Dahai Hu
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - Songtao Xie
- Department of Burns and Cutaneous Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shanxi, China
| | - Guoan Zhang
- Department of Burns, Beijing Jishuitan Hospital, Forth Medical College of Peking University, Beijing, China
| | - Chunmao Han
- Department of Burns & Wound Care Center, The Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, China
| | - Xiaoyuan Huang
- Department of Burns and Plastic Surgery, Central South University, Changsha, Hunan, China
| | - Ciyu Jia
- Graduate School, Medical College of Chinese PLA, Beijing, China
| | - Jiake Chai
- Department of Burn & Plastic Surgery, The First Affiliated Hospital of PLA General Hospital, Beijing, China
| | - Jingning Huan
- Department of Burn and Plastic Surgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Guanghua Guo
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Jianhua Zhan
- Department of Critical Care Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Weiguo Xie
- Department of Anesthesia and Critical Care, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ying Cen
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Rong Yu
- Department of Otorhinolaryngology Head and Neck Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Huade Chen
- Department of Burns, General Hospital of Guangdong Province, Guangzhou, Guangdong, China
| | - Xihua Niu
- Department of Otolaryngology, Henan Province Hospital, Zhengzhou, Henan, China
| | - Yibing Wang
- Department of Aesthetic Plastic and Burn Surgery, Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Jinfeng Fu
- Department of Burns, Second Affiliated Hospital of Kunmin Medical University, Yunnan, China
| | - Baosheng Xue
- Department of Burns, The First Affiliated Hospital of Chinese Medical University, Shenyang, Liaoning, China
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Candida identification: a journey from conventional to molecular methods in medical mycology. World J Microbiol Biotechnol 2014; 30:1437-51. [PMID: 24379160 DOI: 10.1007/s11274-013-1574-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 12/02/2013] [Indexed: 12/17/2022]
Abstract
The incidence of Candida infections have increased substantially in recent years due to aggressive use of immunosuppressants among patients. Use of broad-spectrum antibiotics and intravascular catheters in the intensive care unit have also attributed with high risks of candidiasis among immunocompromised patients. Among Candida species, C. albicans accounts for the majority of superficial and systemic infections, usually associated with high morbidity and mortality often caused due to increase in antimicrobial resistance and restricted number of antifungal drugs. Therefore, early detection of candidemia and correct identification of Candida species are indispensable pre-requisites for appropriate therapeutic intervention. Since blood culture based methods lack sensitivity, and species-specific identification by conventional method is time-consuming and often leads to misdiagnosis within closely related species, hence, molecular methods may provide alternative for accurate and rapid identification of Candida species. Although, several molecular approaches have been developed for accurate identification of Candida species but the internal transcribed spacer 1 and 2 (ITS1 and ITS2) regions of the rRNA gene are being used extensively in a variety of formats. Of note, ITS sequencing and PCR-RFLP analysis of ITS region seems to be promising as a rapid, easy, and cost-effective method for identification of Candida species. Here, we review a number of existing techniques ranging from conventional to molecular approaches currently in use for the identification of Candida species. Further, advantages and limitations of these methods are also discussed with respect to their discriminatory power, reproducibility, and ease of performance.
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Changing pattern of fungal infection in burn patients. Burns 2011; 38:520-8. [PMID: 22035885 DOI: 10.1016/j.burns.2011.09.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2011] [Revised: 09/24/2011] [Accepted: 09/29/2011] [Indexed: 11/21/2022]
Abstract
Invasive fungal burn wound infection is an important emerging cause of late onset morbidity and high mortality in patients with major burns. Following a pilot study done in our unit in 1 year, i.e. January 2008-March 2009 in 71 patients where 28% (20 patients) of the burn wound biopsies from suspected cases showed fungal wound invasion (FWI), a detailed study was planned in order to study the epidemiology of fungal infection in burns in our unit wherein routine wound biopsies in 100 patients were sent on 7th, 14th and 21st postburn day over a one year period (July 2009-June 2010). 12 patients (12%) were diagnosed with FWI on culture. This was then followed by another study in a 9 month period (July 2010-March 2011) when wound samples for only 36 patients in whom there was clinical suspicion of fungal infection were sent. 16 of these patients were diagnosed with fungal wound invasion (FWI) thus establishing an incidence of 44% from suspected cases. These studies showing the increase in fungal infection in our unit have therefore made us wiser, increased our awareness and our accuracy in diagnosing this uncommon infection in extensive burns where patient is not only severely immunocompromised but also has many other risk factors making them more vulnerable to fungal invasion. Another glaring fact which emerged from these studies was the rising incidence of nonalbicans Candida infection compared to Candida albicans, especially C. tropicalis and C. krusei which are more severe in nature and associated with a higher mortality. This signifies that there is a shift of FWI in burns from commensal organism, i.e. C. albicans to pathogenic nosocomial organisms, i.e. C. nonalbicans.
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22
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Capoor MR, Sarabahi S, Tiwari VK, Narayanan RP. Fungal infections in burns: Diagnosis and management. Indian J Plast Surg 2011; 43:S37-42. [PMID: 21321655 PMCID: PMC3038393 DOI: 10.4103/0970-0358.70718] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Burn wound infection (BWI) is a major public health problem and the most devastating form of trauma worldwide. Fungi cause BWI as part of monomicrobial or polymicrobial infection, fungaemia, rare aggressive soft tissue infection and as opportunistic infections. The risk factors for acquiring fungal infection in burns include age of burns, total burn size, body surface area (BSA) (30-60%), full thickness burns, inhalational injury, prolonged hospital stay, late surgical excision, open dressing, artificial dermis, central venous catheters, antibiotics, steroid treatment, long-term artificial ventilation, fungal wound colonisation (FWC), hyperglycaemic episodes and other immunosuppressive disorders. Most of the fungal infections are missed owing to lack of clinical awareness and similar presentation as bacterial infection coupled with paucity of mycology laboratories. Expedient diagnosis and treatment of these mycoses can be life-saving as the mortality is otherwise very high. Emergence of resistance in non-albicans Candida spp., unusual yeasts and moulds in fungal BWI, leaves very few fungi susceptible to antifungal drugs, leaving many patients susceptible. There is a need to speciate fungi as far as the topical and systemic antifungal is concerned. Deep tissue biopsy and other relevant samples are processed by standard mycological procedures using direct microscopy, culture and histopathological examination. Patients with FWC should be treated by aggressive surgical debridement and, in the case of fungal wound infection (FWI), in addition to surgical debridement, an intravenous antifungal drug, most commonly amphotericin B or caspofungin, is prescribed followed by de-escalating with voriconazole or itraconazole, or fluconazole depending upon the species or antifungal susceptibility, if available. The propensity for fungal infection increases, the longer the wound is present. Therefore, the development of products to close the wound more rapidly, improvement in topical antifungal therapy with mould activity and implementation of appropriate systemic antifungal therapy guided by antifungal susceptibility may improve the outcome for severely injured burn victims.
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Affiliation(s)
- Malini R Capoor
- Department of Micrbiology Vardhman Mahaveer Medical College & Safdarjung Hospital, Delhi - 110 029, India
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Capoor MR, Gupta S, Sarabahi S, Mishra A, Tiwari VK, Aggarwal P. Epidemiological and clinico-mycological profile of fungal wound infection from largest burn centre in Asia. Mycoses 2011; 55:181-8. [PMID: 21740469 DOI: 10.1111/j.1439-0507.2011.02065.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The current study was conducted to know the incidence, predisposing factors, spectrum, clinical profile and antifungal susceptibility (AFS) of fungal wound infection (FWI) in burn patients. Of a total of 71 patients, 20 (28.2%) emerged with the diagnosis of FWI. Fungal pathogens in this study were Candida tropicalis (14%), Candida parapsilosis (5.6%), Aspergillus niger (2.8%) and one each of Candida albicans (1.4%), Candida glabrata (1.4%), Syncephalestrum (1.4%) and Fusarium solani (1.4%). All patients with mould infections expired before the mycological culture results could be conveyed to clinicians. Of the yeasts isolated in the study, one each of C. tropicalis and C. albicans showed cross-resistance to azoles. All the moulds were susceptible to amphotericin B. This study depicted that fungal invasion is associated with a high mortality, burn size 30-60% and high incidence of inhalational injury. Fungal invasion was detected on an average of 14 days after injury. Association of use of four classes of drugs - aminoglycosides, imipenem, vancomycin and third generation cephalosporins and use of total parenteral nutrition was observed. Expedient laboratory diagnosis of FWI and appropriate systemic antifungal therapy guided by AFS may improve outcome for severely injured burn victims.
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Affiliation(s)
- Malini R Capoor
- Department of Microbiology, Vardhman Mahaveer Medical College & Safdarjung Hospital, New Delhi, India.
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Ha JF, Italiano CM, Heath CH, Shih S, Rea S, Wood FM. Candidemia and invasive candidiasis: a review of the literature for the burns surgeon. Burns 2010; 37:181-95. [PMID: 20395056 DOI: 10.1016/j.burns.2010.01.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2009] [Revised: 12/05/2009] [Accepted: 01/06/2010] [Indexed: 10/19/2022]
Abstract
Advances in critical care, operative techniques, early fluid resuscitation, antimicrobials to control bacterial infections, nutritional support to manage the hypermetabolic response and early wound excision and coverage has improved survival rates in major burns patients. These advances in management have been associated with increased recognition of invasive infections caused by Candida species in critically ill burns patients. Candida albicans is the most common species to cause invasive Candida infections, however, non-albicans Candida species appear to becoming more frequent. These later species may be less fluconazole susceptible than Candida albicans. High crude and attributable mortality rates from invasive Candida sepsis are multi-factorial. Diagnosis of invasive candidiasis and candidemia remains difficult. Prophylactic and pre-emptive therapies appear promising strategies, but there is no specific approach which is well-studied and clearly efficacious in high-risk burns patients. Treatment options for invasive candidiasis include several amphotericin B formulations and newer less toxic antifungal agents, such as azoles and echinocandins. We review the currently available data on diagnostic and management strategies for invasive candidiasis and candidemia; whenever possible providing reference to the high-risk burn patients. We also present an algorithm for the management of candidemia and invasive candidiasis in burn patients.
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Affiliation(s)
- Jennifer F Ha
- Telstra Burns Unit, Department of Plastic Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
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Goyal NK, Gore MA, Goyal RS. Fungal colonisation in burn wounds: An Indian scenerio. Indian J Surg 2010; 72:49-52. [PMID: 23133204 DOI: 10.1007/s12262-010-0009-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2009] [Accepted: 05/18/2009] [Indexed: 11/28/2022] Open
Abstract
UNLABELLED Burn patients are susceptible hosts for fungal colonisation. AIM To study incidence and profile of fungal colonisation of burn wounds. MATERIALS AND METHODS This prospective study was conducted in 201 consecutive adult patients (39 male and 162 female) with burn wounds, admitted from October 2005 to September 2006. Wounds with clinical suspicion of fungal colonisation were biopsied and examined by wet smear, Potassium hydroxide (KOH) mount, nigrosin stain, 1% Acid fast bacilli (AFB) stain, Gomori methenamine silver (GMS) stain, histopathological examination and fungal culture. All wounds with suspicion of fungal colonisation were treated with topical application of miconazole ointment mixed with povidone-iodine/silver sulphadiazine topically and itraconazole (oral) systemically. RESULTS Fungal infection of burn wound was suspected in 77 patients (38.31%) with 20-70% total body surface area (TBSA) burns. Ninety-two biopsy samples were collected from 77 patients. On investigations, fungal colonisation was confirmed in 35 patients. Culture was positive in 23 patients with Candida in 12 and Aspergillus in 4. GMS stain and KOH stain showed sensitivity and specificity of 70.8% and 86.5%, respectively for detecting fungi in burn wound. Nigrosin stain was negative in all patients. Duration of hospitalisation was more in patients having fungal colonisation without any significant effect on the mortality DISCUSSION In 38.31% of patients fungal colonisation was clinically suspected and it was confirmed in 17.41% of 201 patients. GMS stain and KOH stain were observed to have acceptable sensitivity and specificity. With increasing prevalence of Aspergillus, flucanazole cannot be relied upon in controlling fungal colonisation and drugs like itraconazole may have to be used as empirical therapy. CONCLUSION Fungal colonisation of burn wound is not uncommon and should be suspected. Fungi detected most commonly were Candida and Aspergillus. KOH and GMS stain were identified as reliable, simple and inexpensive methods for confirming fungal colonisation.
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Affiliation(s)
- Navin Kumar Goyal
- Department of Surgery, LTM Medical College, Sion, Mumbai, Maharashtra India
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Vinsonneau C, Benyamina M, Baixench M, Stephanazzi J, Augris C, Grabar S, Paugam A, Wassermann D. Effects of candidaemia on outcome of burns. Burns 2009; 35:561-4. [DOI: 10.1016/j.burns.2008.05.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2008] [Accepted: 05/28/2008] [Indexed: 10/21/2022]
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Schelenz S, Barnes R, Kibbler C, Jones B, Denning D. Standards of care for patients with invasive fungal infections within the United Kingdom: A national audit. J Infect 2009; 58:145-53. [DOI: 10.1016/j.jinf.2008.12.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2008] [Revised: 10/17/2008] [Accepted: 12/19/2008] [Indexed: 10/21/2022]
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Abstract
Fungal infections are increasingly common in burn patients. We performed this study to determine the incidence and outcomes of fungal cultures in acutely burned patients. Members of the American Burn Association's Multicenter Trials Group were asked to review patients admitted during 2002-2003 who developed one or more cultures positive for fungal organisms. Data on demographics, site(s), species and number of cultures, and presence of risk factors for fungal infections were collected. Patients were categorized as untreated (including prophylactic topical antifungals therapy), nonsystemic treatment (nonprophylactic topical antifungal therapy, surgery, removal of foreign bodies), or systemic treatment (enteral or parenteral therapy). Fifteen institutions reviewed 6918 patients, of whom 435 (6.3%) had positive fungal cultures. These patients had mean age of 33.2 +/- 23.6 years, burn size of 34.8 +/- 22.7%TBSA, and 38% had inhalation injuries. Organisms included Candida species (371 patients; 85%), yeast non-Candida (93 patients, 21%), Aspergillus (60 patients, 14%), other mold (39 patients, 9.0%), and others (6 patients, 1.4%). Systemically treated patients were older, had larger burns, more inhalation injuries, more risk factors, a higher incidence of multiple positive cultures, and significantly increased mortality (21.2%), compared with nonsystemic (mortality 5.0%) or untreated patients (mortality 7.8%). In multivariate analysis, increasing age and burn size, number of culture sites, and cultures positive for Aspergillus or other mold correlated with mortality. Positive fungal cultures occur frequently in patients with large burns. The low mortality for untreated patients suggests that appropriate clinical judgment was used in most treatment decisions. Nonetheless, indications for treatment of fungal isolates in burn patients remain unclear, and should be developed.
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Abstract
BACKGROUND Topical silver treatments and silver dressings are increasingly used for the local treatment of contaminated or infected wounds, however, there is a lack of clarity regarding the evidence for their effectiveness. OBJECTIVES To evaluate the effects on wound healing of topical silver and silver dressings in the treatment of contaminated and infected acute or chronic wounds. SEARCH STRATEGY We sought relevant trials from the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Wounds Group Specialised Register in March 2006 and in MEDLINE, EMBASE, CINAHL, and digital dissertations databases up to September 2006. In addition, we contacted companies, manufacturers and distributors for information to identify relevant trials. SELECTION CRITERIA Randomised controlled trials (RCTs) assessing the effectiveness of topical silver in the treatment of contaminated and infected acute or chronic wounds. DATA COLLECTION AND ANALYSIS Eligibility of trials, assessment of trial quality and data extraction were undertaken by two authors independently. Disagreements were referred to a third author. MAIN RESULTS Three RCTs were identified, comprising a total of 847 participants. One trial compared silver-containing foam (Contreet) with hydrocellular foam (Allevyn) in patients with leg ulcers. The second trial compared a silver-containing alginate (Silvercel) with an alginate alone (Algosteril). The third trial compared a silver-containing foam dressing (Contreet)) with best local practice in patients with chronic wounds.The data from these trials show that silver-containing foam dressings did not significantly increase complete ulcer healing as compared with standard foam dressings or best local practice after up to four weeks of follow-up, although a greater reduction of ulcer size was observed with the silver-containing foam. The use of antibiotics was assessed in two trials, but no significant differences were found. Data on pain, patient satisfaction, length of hospital stay, and costs were limited and showed no differences. Leakage occurred significantly less frequently in patients with leg ulcers and chronic wounds treated with a silver dressing than with a standard foam dressing or best local practice in one trial. AUTHORS' CONCLUSIONS Only three trials with a short follow-up duration were found. There is insufficient evidence to recommend the use of silver-containing dressings or topical agents for treatment of infected or contaminated chronic wounds.
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Affiliation(s)
- H Vermeulen
- Academic Medical Centre, University of Amsterdam, Department of Surgery, Meibergdreef 9, PO Box 22700, Amsterdam, Netherlands, 1100 DE.
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