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Nosanov LB, Johnson L. When the fungus is among us: does colonization portend later invasive fungal infection? Trauma Surg Acute Care Open 2024; 9:e001472. [PMID: 38779364 PMCID: PMC11110557 DOI: 10.1136/tsaco-2024-001472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Affiliation(s)
- Lauren B Nosanov
- Walter L Ingram Burn Center, Grady Health System, Atlanta, Georgia, USA
- Deparment of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Laura Johnson
- Walter L Ingram Burn Center, Grady Health System, Atlanta, Georgia, USA
- Deparment of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
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2
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Gur I, Zilbert A, Toledano K, Roimi M, Stern A. Clinical impact of fungal colonization of burn wounds in patients hospitalized in the intensive care unit: a retrospective cohort study. Trauma Surg Acute Care Open 2024; 9:e001325. [PMID: 38666015 PMCID: PMC11043691 DOI: 10.1136/tsaco-2023-001325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Accepted: 03/30/2024] [Indexed: 04/28/2024] Open
Abstract
Background Invasive fungal infections in burn victims significantly increase mortality and hospitalization. The effect of fungal burn wound colonization has not been established. Methods All adult patients hospitalized in the intensive care unit (ICU) with burns ≥10% of total body surface area (TBSA) between 2005 and 2021 were included. Superficial swabs were collected whenever clinical suspicion of wound colonization was raised, and deep tissue samples were sent at any wound excision. The primary outcome was the incidence of invasive fungal infections defined as any deep tissue fungal infection or fungemia. Results Of 242 patients included, 39 (16.1%) had fungal wound colonization, 22 (56.4%) with yeasts and 24 (61.5%) molds. Patients with fungal colonization had a significantly higher rate of invasive fungal infections (82.1% vs 3.9%, p<0.001), candidemia (15.4% vs 3.4%, p=0.002), as well as longer ICU stay (61.5±57.6 vs 19±40.5 days, p<0.001), and higher in-ICU mortality (43.6% vs 15.8%, p<0.001). Survival analysis showed fungal colonization to be associated with significantly increased risk of invasive infection (aHR 25, 95% CI (9.67 to 64.62)), even when adjusted for age, TBSA, sequential organ failure assessment scores, Charlson Comorbidity Index and the presence of bacteremia. Conclusions Fungal burn wound colonization is associated with increased risk of invasive fungal infections and mortality. Level of Evidence This a single center, retrospective cohort study.
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Affiliation(s)
- Ivan Gur
- Rambam Health Care Campus, Haifa, Israel
| | | | - Kochava Toledano
- Rambam Health Care Campus, Haifa, Israel
- Technion Israel Institute of Technology, Haifa, Israel
| | - Michael Roimi
- Rambam Health Care Campus, Haifa, Israel
- Technion Israel Institute of Technology, Haifa, Israel
| | - Anat Stern
- Rambam Health Care Campus, Haifa, Israel
- Technion Israel Institute of Technology, Haifa, Israel
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3
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Orbay H, Ziembicki JA, Yassin M, Egro FM. Prevention and Management of Wound Infections in Burn Patients. Clin Plast Surg 2024; 51:255-265. [PMID: 38429048 DOI: 10.1016/j.cps.2023.11.003] [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] [Indexed: 03/03/2024]
Abstract
The leading cause of morbidity in burn patients is infection with pneumonia, urinary tract infection, cellulitis, and wound infection being the most common cause. High mortality is due to the immunocompromised status of patients and abundance of multidrug-resistant organisms in burn units. Despite the criteria set forth by American Association of Burn, the diagnosis and treatment of burn infections are not always straightforward. Topical antimicrobials, isolation, hygiene, and personal protective equipment are common preventive measures. Additionally medical and nutritional optimization of the patients is crucial to reverse the immunocompromised status triggered by burn injury.
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Affiliation(s)
- Hakan Orbay
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jenny A Ziembicki
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Mohamed Yassin
- Division of Infectious Diseases, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Francesco M Egro
- Department of Plastic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA; Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA.
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4
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Piccoli P, Lucini F, Al-Hatmi AMS, Rossato L. Fusariosis in burn patients: A systematic review of case reports. Med Mycol 2024; 62:myae013. [PMID: 38379099 DOI: 10.1093/mmy/myae013] [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: 07/04/2023] [Revised: 01/16/2024] [Accepted: 02/19/2024] [Indexed: 02/22/2024] Open
Abstract
Burns can cause skin damage, facilitating the entry of fungi and other microorganisms into the body, leading to infections. Fusarium is a fungus capable of infecting individuals with burn injuries. Diagnosing and treating Fusarium infections in burn patients can be challenging due to the manifestation of nonspecific symptoms. This study aims to investigate case reports and case series from published literature describing Fusarium infection in burned patients, in order to assess treatment regimens, clinical outcomes, and make recommendations for future management. We conducted searches on Web of Science, PubMed, ScienceDirect, and Medline for all case reports and case series containing keywords 'Burn', 'Burns', 'Burned', 'Fusarium', or 'Fusariosis' in the title or abstract. All burn patients who developed Fusarium fungal infections between January 1974 and March 2023 were included in the study. Demographic and clinical data were analyzed retrospectivity. The final analysis incorporates 24 case reports encompassing a total of 87 burn patients with Fusarium infection. Patient ages ranged from one to 85 years, with the majority being male (53%). The median percentage of burn surface area was 78%, and the skin in the face, upper limbs, and lower limbs were the most commonly infected sites. Fungal infections appeared around 10 days after the burn injury on average. The majority of the patients were identified through culture or histopathology. The Fusarium dimerum species complex, which was found in nine patients, was the most frequently identified Fusarium species complex. Amphotericin B was the most preferred treatment drug, followed by voriconazole, and 62% of patients underwent debridement. In our study, 23 patients (37%) died from fungal infections. Implementing early and effective treatment protocols targeting Fusarium spp. in burn treatment units can significantly reduce mortality rates. It is critical to enhance the understanding of fusariosis epidemiology and emphasize the importance of maintaining a high clinical suspicion for this condition in burn patients.
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Affiliation(s)
- Paola Piccoli
- Federal University of Grande Dourados (UFGD), Faculdade de Ciências da Saúde-FCS, Brazil
| | - Fabíola Lucini
- Federal University of Grande Dourados (UFGD), Faculdade de Ciências da Saúde-FCS, Brazil
| | | | - Luana Rossato
- Federal University of Grande Dourados (UFGD), Faculdade de Ciências da Saúde-FCS, Brazil
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5
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Tan XYD, Wiseman T, Betihavas V. Risk factors for nosocomial infections and/or sepsis in adult burns patients: An integrative review. Intensive Crit Care Nurs 2022; 73:103292. [PMID: 35879132 DOI: 10.1016/j.iccn.2022.103292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 06/06/2022] [Accepted: 06/12/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND In comparison to general trauma patients, loss of skin barrier amongst the burns cohort predisposes them to a higher risk of nosocomial infections and sepsis, and this often leads to unfavourable morbidity and mortality outcomes. PURPOSE This integrative review aimed to explore existing literature to identify risk factors related to nosocomial infections and/or sepsis in adult burns patients following hospital admission. METHODS Electronic searches for journals published between 2007 and 2021 were performed in CINAHL, Scopus and Medline, and key journals were hand-searched. Inclusion criteria was: (1) peer-reviewed, primary studies; (2) qualitative, quantitative or mixed-methods studies; (3) study participants had sustained burns-related injury and developed nosocomial infections and/or sepsis during the course of hospitalisation. Studies were appraised using the Critical Appraisal Skill Program checklists. RESULTS 15 studies ranging from 'poor' to 'fair' to 'moderate' quality were included in the final review. Patient factors that contributed to the development of nosocomial infections and/ or sepsis included: (1) Full thickness burns; (2) age; (3) % Total Burns Surface Area; and (4) Herpes Simplex Virus activation. Several provider-system risk factors were identified by 'poor' quality studies and further research is required to substantiate those findings. DISCUSSION Findings remained inconclusive due to the lack of 'good' quality studies however, there was an overemphasis on patient-related risk factors instead of healthcare workers or the system. Future research may focus on activation of the latest infection prevention strategies and early enforcement of care bundles. Through identification of related risk factors, it may reduce the incidence of nosocomial infection and/or sepsis post-burns.
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Affiliation(s)
- Xue Ying Debbie Tan
- Susan Wakil School of Nursing & Midwifery, Susan Wakil School of Nursing & Midwifery, Australia.
| | - Taneal Wiseman
- Susan Wakil School of Nursing & Midwifery, Susan Wakil School of Nursing & Midwifery, Australia
| | - Vasiliki Betihavas
- Susan Wakil School of Nursing & Midwifery, Susan Wakil School of Nursing & Midwifery, Australia
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6
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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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7
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O Sousa MA, de Faria MAC, Ribeiro RP, Valverde JVP, Rocha HD, Dos Santos KF, Sousa MS, Souto PCS, Silva JR, de Souza NC. Latex membranes with methylene blue dye for antimicrobial photodynamic therapy. Photochem Photobiol Sci 2021; 20:1027-1032. [PMID: 34292539 DOI: 10.1007/s43630-021-00077-z] [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: 01/20/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
The search for new materials that can be applied in the treatment of injured human tissues has led to the development of new dressings. Membranes have potential as dressing materials because they can be fitted to and interact with the tissue surface. In this study, we analyze the morphological properties and wettability of latex membranes, along with the incorporation of the photosensitizer methylene blue, in the context of the utility of the membranes in curative applications involving photodynamic therapy (PDT). It was observed that deposition of the photosensitizer into latex membranes increased both the surface roughness and wettability. Antifungal testing indicated that antimicrobial PDT assisted by the latex membranes incorporating methylene blue effectively inactivated Candida albicans.
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Affiliation(s)
- Maria Andrelina O Sousa
- Grupo de Materiais Nanoestruturados, Universidade Federal de Mato Grosso, Barra do Garças, Mato Grosso, Brazil
| | - Marco A C de Faria
- Grupo de Materiais Nanoestruturados, Universidade Federal de Mato Grosso, Barra do Garças, Mato Grosso, Brazil
| | - Rita P Ribeiro
- Grupo de Materiais Nanoestruturados, Universidade Federal de Mato Grosso, Barra do Garças, Mato Grosso, Brazil
| | - João V P Valverde
- Grupo de Materiais Nanoestruturados, Universidade Federal de Mato Grosso, Barra do Garças, Mato Grosso, Brazil
| | - Herica D Rocha
- Grupo de Materiais Nanoestruturados, Universidade Federal de Mato Grosso, Barra do Garças, Mato Grosso, Brazil
| | - Kevin F Dos Santos
- Grupo de Materiais Nanoestruturados, Universidade Federal de Mato Grosso, Barra do Garças, Mato Grosso, Brazil
| | - Marcos S Sousa
- Grupo de Materiais Nanoestruturados, Universidade Federal de Mato Grosso, Barra do Garças, Mato Grosso, Brazil
| | - Paula C S Souto
- Grupo de Materiais Nanoestruturados, Universidade Federal de Mato Grosso, Barra do Garças, Mato Grosso, Brazil
| | - Josmary R Silva
- Grupo de Materiais Nanoestruturados, Universidade Federal de Mato Grosso, Barra do Garças, Mato Grosso, Brazil
| | - Nara C de Souza
- Grupo de Materiais Nanoestruturados, Universidade Federal de Mato Grosso, Barra do Garças, Mato Grosso, Brazil.
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8
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Zhao Y, Zhang Y, Dong J. Evaluating the efficacy of anti-fungal blue light therapies via analyzing tissue section images. Lasers Med Sci 2021; 37:831-841. [PMID: 33945042 DOI: 10.1007/s10103-021-03319-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 04/05/2021] [Indexed: 12/31/2022]
Abstract
Anti-fungal blue light (ABL) therapies have been studied and applied in treating various diseases caused by fungal infection. The existing work has been mainly devoted to study the effect of various light dosages on the fungal viability and on the induced cytotoxic reactive oxygen species (ROS) in the pathogens. While in vivo experimental studies have also been reported, there is still no work targeted on quantifying the effect of light on prohibiting the pathogens from invading into the deeper sites in the skin of their host. This can be attributed to the lack of methods to analyze the tissue section images, which are the main means of examining infected tissues. This work has been devoted to solve such problems, so as to improve dosimetric analyses of ABL therapies on treating fungal infections. Specifically, the invasion depth of the fungi and their ratios to the tissue in four bins at different depths inside the skin were extracted from the tissue section images. The significance of the treatment with different dosages on inhibiting the fungi was also tested by each of these depth-related metrics. The ABL experiments using 415-nm-wavelength LED light were performed on BALB/c mice, whose skin was infected by Candida albicans (C. albicans). The proposed methods were applied to the tissue sections of the experimental animals. The results clearly verified that the fluence up to 180J/cm2 can significantly prohibit the fungal infection into the skin in terms of almost all the newly proposed metrics.
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Affiliation(s)
- Yun Zhao
- University of Science and Technology of China, Hefei, China.,Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Yunchu Zhang
- University of Science and Technology of China, Hefei, China.,Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China
| | - Jianfei Dong
- Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, China.
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9
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Active neutrophil responses counteract Candida albicans burn wound infection of ex vivo human skin explants. Sci Rep 2020; 10:21818. [PMID: 33311597 PMCID: PMC7732850 DOI: 10.1038/s41598-020-78387-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 11/13/2020] [Indexed: 12/14/2022] Open
Abstract
Burn wounds are highly susceptible sites for colonization and infection by bacteria and fungi. Large wound surface, impaired local immunity, and broad-spectrum antibiotic therapy support growth of opportunistic fungi such as Candida albicans, which may lead to invasive candidiasis. Currently, it remains unknown whether depressed host defenses or fungal virulence drive the progression of burn wound candidiasis. Here we established an ex vivo burn wound model, where wounds were inflicted by applying preheated soldering iron to human skin explants, resulting in highly reproducible deep second-degree burn wounds. Eschar removal by debridement allowed for deeper C. albicans penetration into the burned tissue associated with prominent filamentation. Active migration of resident tissue neutrophils towards the damaged tissue and release of pro-inflammatory cytokine IL-1β accompanied the burn. The neutrophil recruitment was further increased upon supplementation of the model with fresh immune cells. Wound area and depth decreased over time, indicating healing of the damaged tissue. Importantly, prominent neutrophil presence at the infected site correlated to the limited penetration of C. albicans into the burned tissue. Altogether, we established a reproducible burn wound model of candidiasis using ex vivo human skin explants, where immune responses actively control the progression of infection and promote tissue healing.
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10
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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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11
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Palackic A, Popp D, Tapking C, Houschyar KS, Branski LK. Fungal Infections in Burn Patients. Surg Infect (Larchmt) 2020; 22:83-87. [PMID: 33035112 DOI: 10.1089/sur.2020.299] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Background: Fungal burn wound infections are among the most devastating complications in patients who are severely burned. Increasing incidence of burn wound infections caused by fungi led to new challenges in diagnostic and therapeutic approaches. The wide use of broad-spectrum antibiotic agents, an increased prevalence of molds and non-Candida albicans spp., and the variety of available antifungal agents underline the importance of identifying the causative species, to initiate adequate therapy within an adequate timeframe. Methods: Review of the pertinent English and German literature. Results: Fungal burn wound infections go along with a delay of identifying the causative fungus species and can be mistaken for early bacterial burn wound infection. Recently, an increase of uncommon fungal pathogens and fungi resistance against antifungal agents has been reported. Amphotericin B and voriconazole remain the antifungal drugs used most commonly. Conclusions: Adequate therapy remains challenging. Early radical debridement and wound closure play an imperative part, particularly in preventing infections caused by yeasts and molds or any other agent. Prophylactic empiric pharmacologic treatment is reserved for those highly at risk for invasive burn wound infection only. Because of the emergence of drug-resistant fungi, the development of new antifungal drugs is essential for the battle against fungal burn wound infections.
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Affiliation(s)
- Alen Palackic
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Daniel Popp
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
| | - Christian Tapking
- Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany
| | - Khosrow S Houschyar
- Clinic of Dermatology and Allergology, University Hospital RWTH Aachen, Aachen, Germany
| | - Ludwik K Branski
- Department of Surgery, Shriners Hospitals for Children, University of Texas Medical Branch, Galveston, Texas, USA
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12
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Arenales A, Gardiner CH, Miranda FR, Dutra KS, Oliveira AR, Mol JP, Texeira da Costa ME, Tinoco HP, Coelho CM, Silva RO, Pinto HA, Hoppe EG, Werther K, Santos RL. Pathology of Free-Ranging and Captive Brazilian Anteaters. J Comp Pathol 2020; 180:55-68. [PMID: 33222875 DOI: 10.1016/j.jcpa.2020.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/30/2020] [Accepted: 08/26/2020] [Indexed: 11/15/2022]
Abstract
There is little information on the anatomical pathology of Brazilian anteaters. Considering the relevance of knowledge of diseases of these species for their conservation, the aim of this study was to describe pathological changes in 99 captive and free-ranging anteaters from the Brazilian states of São Paulo, Minas Gerais, Bahia, Mato Grosso do Sul and Amazonas. Forty-two animals were killed on roads and 10 died from burns injuries. Other significant conditions included the metabolic diseases of iron storage disease, tissue mineralization and taurine deficiency, protozoan and metazoan infections, candidiasis, sporotrichosis, clostridiosis and proliferative disorders including squamous cell carcinoma.
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Affiliation(s)
- Alexandre Arenales
- Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Chris H Gardiner
- Veterinary Pathology Service Joint Pathology Center, Silver Spring, Maryland, USA
| | | | - Kateanne S Dutra
- Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ayisa R Oliveira
- Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Juliana Ps Mol
- Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Maria El Texeira da Costa
- Fundação de Parques Municipais e Zoobotânica de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | - Herlandes P Tinoco
- Fundação de Parques Municipais e Zoobotânica de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | - Carlyle M Coelho
- Fundação de Parques Municipais e Zoobotânica de Belo Horizonte, Belo Horizonte, Minas Gerais, Brazil
| | - Rodrigo Os Silva
- Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Hudson A Pinto
- Departamento de Parasitologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Estevam Gl Hoppe
- Departamento de Medicina Veterinária Preventiva e Reprodução Animal, Faculdade de Ciências Agrárias e Veterinárias, Universidade Estadual Paulista, Brazil
| | - Karin Werther
- Departamento de Patologia Veterinária, Faculdade de Ciências Agrárias e Veterinárias, Universidade Estadual Paulista, Jaboticabal, São Paulo, Brazil
| | - Renato Lima Santos
- Escola de Veterinária, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil.
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13
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Efficacy of topical platelet-rich plasma and chitosan co-administration on Candida albicans-infected partial thickness burn wound healing. Burns 2020; 46:1889-1895. [PMID: 32591195 DOI: 10.1016/j.burns.2020.05.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 05/11/2020] [Accepted: 05/21/2020] [Indexed: 02/07/2023]
Abstract
This study aims to evaluate the effects of topical sole and co-administration of Platelet-rich plasma (PRP) and chitosan on the infected burn wounds model by Candida albicans in Wistar rats. A circle partial thickness contact burn wound model occurred via brass a size of 8mm diameter between the shoulders and after that, 50μl of a suspension containing C. albicans yeast (5×107) colony forming unit was poured on the surface of the wound. The experimental groups included Control, Clotrimazole, PRP and Chitosan+PRP that received any agent, Clotrimazole®, PRP and Chitosan+PRP to treat the wound, respectively. To assess the healing rate, wound size rate, tissue yeast count (TYC) and immunohistochemical staining for heat shock protein 70 (HSP70), HSP 90 and proliferating cell nuclear antigen (PCNA) were conducted. Moreover, enzymatic activity of glutathione peroxidase (GPx), superoxide dismutase (SOD) and malondialdehyde (MDA) rate were evaluated. The results demonstrated that the co-administration of Chitosan+PRP drastically (P<0.05) decreased the wound size and TYC rate comparing to other groups (P<0.05). Immunohistochemical results for HSP 70, HSP 90 and PCNA showed positive reactions and increased intensity in all the treated groups comparing to the control group. Activities of GPx and SOD were higher and the level of MDA was lower all treated groups compared to the control group. A topical use of PRP and chitosan can be advantageous in the infected burn wounds healing.
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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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15
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Sanjar F, Weaver AJ, Peacock TJ, Nguyen JQ, Brandenburg KS, Leung KP. Temporal shifts in the mycobiome structure and network architecture associated with a rat (Rattus norvegicus) deep partial-thickness cutaneous burn. Med Mycol 2020; 58:107-117. [PMID: 31041451 PMCID: PMC6939685 DOI: 10.1093/mmy/myz030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 02/01/2019] [Accepted: 03/11/2019] [Indexed: 12/22/2022] Open
Abstract
With a diverse physiological interface to colonize, mammalian skin is the first line of defense against pathogen invasion and harbors a consortium of microbes integral in maintenance of epithelial barrier function and disease prevention. While the dynamic roles of skin bacterial residents are expansively studied, contributions of fungal constituents, the mycobiome, are largely overlooked. As a result, their influence during skin injury, such as disruption of skin integrity in burn injury and impairment of host immune defense system, is not clearly delineated. Burn patients experience a high risk of developing hard-to-treat fungal infections in comparison to other hospitalized patients. To discern the changes in the mycobiome profile and network assembly during cutaneous burn-injury, a rat scald burn model was used to survey the mycobiome in healthy (n = 30) (sham-burned) and burned (n = 24) skin over an 11-day period. The healthy skin demonstrated inter-animal heterogeneity over time, while the burned skin mycobiome transitioned toward a temporally stabile community with declining inter-animal variation starting at day 3 post-burn injury. Driven primarily by a significant increase in relative abundance of Candida, fungal species richness and abundance of the burned skin decreased, especially in days 7 and 11 post-burn. The network architecture of rat skin mycobiome displayed community reorganization toward increased network fragility and decreased stability compared to the healthy rat skin fungal network. This study provides the first account of the dynamic diversity observed in the rat skin mycobiome composition, structure, and network assembly associated with postcutaneous burn injury.
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Affiliation(s)
- Fatemeh Sanjar
- Dental and Craniofacial Trauma Research and Tissue Regeneration Directorate, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - Alan J Weaver
- Dental and Craniofacial Trauma Research and Tissue Regeneration Directorate, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - Trent J Peacock
- Office of Research Compliance, Mississippi State University, Mississippi, USA
| | - Jesse Q Nguyen
- Dental and Craniofacial Trauma Research and Tissue Regeneration Directorate, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - Kenneth S Brandenburg
- Dental and Craniofacial Trauma Research and Tissue Regeneration Directorate, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
| | - Kai P Leung
- Dental and Craniofacial Trauma Research and Tissue Regeneration Directorate, US Army Institute of Surgical Research, JBSA Fort Sam Houston, Texas, USA
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16
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Antibiotic ointment versus a silver-based dressing for children with extremity burns: A randomized controlled study. J Pediatr Surg 2019; 54:1391-1396. [PMID: 29983189 DOI: 10.1016/j.jpedsurg.2018.06.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 05/25/2018] [Accepted: 06/03/2018] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Antibiotic or silver-based dressings are widely used in burn wound care. Our standard method of dressing pediatric extremity burn wounds consists of an antibiotic ointment or nystatin ointment-impregnated nonadherent gauze (primary layer), followed by rolled gauze, soft cast pad, plaster and soft casting tape (3M™ Scotchcast™, St. Paul, MN). The aim of this study was to compare our standard ointment-based primary layer versus Mepitel Ag® (Mölnlycke Health Care, Gothenburg, Sweden) in the management of pediatric upper and lower extremity burn wounds. METHODS Children with a new burn injury to the upper or lower extremities, who presented to the burn clinic were eligible. Eligible children were enrolled and randomized, stratified by burn thickness, to be dressed in an ointment-based dressing or Mepitel Ag®. Study personnel and participants were not blinded to the dressing assignment after randomization. Dressings were changed approximately once or twice per week, until the burn wound was healed or skin-grafted. The primary outcome was time to wound healing and p-value < 0.05 was considered significant. RESULTS Ninety-six children with 113 upper or lower extremity burns were included in the analysis. Mepitel Ag® (hazard ratio [HR] 0.57 (95% Confidence Interval (CI) 0.40-0.82); p = 0.002) significantly reduced the rate of wound healing, adjusting for burn thickness and fungal wound infection. The incidence of fungal wound infections and skin grafting was similar between the two groups. Children randomized to standard ointment dressings were significantly less likely to require four or more burn clinic visits than those in the Mepitel Ag® (4% versus 27%; p = 0.004). CONCLUSION Our study shows that our standard ointment-based dressing significantly increases the rate of wound healing compared to Mepitel Ag® for pediatric extremity burn injuries. LEVEL OF EVIDENCE Treatment study; Level 1.
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17
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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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Okuno E, Jarros IC, Bonfim-Mendonça PS, Vicente de Rezende G, Negri M, Svidzinski TE. Candida parapsilosis isolates from burn wounds can penetrate an acellular dermal matrix. Microb Pathog 2018; 118:330-335. [PMID: 29614369 DOI: 10.1016/j.micpath.2018.03.058] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/18/2018] [Accepted: 03/30/2018] [Indexed: 11/26/2022]
Abstract
We isolated and identified yeasts from burn wounds and evaluated the ability of Candida parapsilosis isolates from burn wounds to penetrate an acellular dermal matrix (ADM). A prospective study was conducted with patients from the burn treatment center of North Paraná University Hospital in Londrina, Brazil from February 2015 to January 2016. Yeast cultures were obtained from the tissue of burn wounds that had been debrided and cleansed with 2% chlorhexidine. After identification and confirmation of the purity of the culture, the yeasts were placed on ADM fragments and incubated for three or seven days. During the study period, 273 patients were treated, and 36 of these patients fulfilled the inclusion criteria and provided samples for culture. Yeasts were isolated in 19.44% (n = 7) of the cultures, and the following species were identified: C. parapsilosis (57.1%), C. albicans (28.6%), and C. glabrata (14.3%). C. parapsilosis, the most frequent species, was chosen for the ADM tests. We demonstrated active penetration of the ADM by the yeast isolates from burn wounds. C. parapsilosis grew on ADM and penetrated the matrix, indicating that this yeast, which is common in skin and cutaneous wounds, has the potential to colonize and pass through ADM, a medical device that is frequently used to dress and regenerate burn wounds.
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Affiliation(s)
- Erika Okuno
- Laboratory of Medical Mycology, State University of Maringá, Brazil; Burn Treatment Center of the North Paraná University Hospital, State University of Londrina, Brazil
| | | | | | | | - Melyssa Negri
- Laboratory of Medical Mycology, State University of Maringá, Brazil
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Lin TC, Wu RX, Chiu CC, Yang YS, Lee Y, Lin JC, Chang FY. The clinical and microbiological characteristics of infections in burn patients from the Formosa Fun Coast Dust Explosion. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2017; 51:267-277. [PMID: 28705768 DOI: 10.1016/j.jmii.2016.08.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 10/19/2022]
Abstract
BACKGROUND/PURPOSE Bloodstream infection is a leading cause of mortality among burn patients. This study aimed to evaluate the risk factors, causative pathogens, and the relationship between bloodstream infections and other infections among burn patients from the Formosa Fun Coast Dust Explosion. METHODS This retrospective study evaluated the demographic and clinical characteristics, infection types, causative pathogen(s), and isolates' antibiotic susceptibilities from patients who were hospitalized between June 27 and September 31, 2015. RESULTS Fifty-eight patients were admitted during the study period (36 males, mean age: 22.6 years). The mean burned total body surface area (TBSA) was 40% for all patients. Eighteen (31%) patients with mean TBSA of 80% had 66 episodes of bloodstream infections caused by 92 isolates. Twelve (18.2%) episodes of bloodstream infections were polymicrobial. Acinetobacter baumannii (19, 20.7%), Ralstonia pickettii (17, 18.5%), and Chryseobacterium meningosepticum (13, 14.1%) were the most common pathogens causing bloodstream infections. A high concordance rate of wound cultures with blood cultures was seen in Staphylococcus aureus (3, 75%) and C. meningosepticum (8, 61.5%) infections. However, no Ralstonia isolate was found in burn wounds of patients with Ralstonia bacteremia. A high concordance rate of central venous catheter cultures with blood cultures was noted in Ralstonia mannitolilytica (5, 62.5%) and Chryseobacterium indologenes (3, 60%) infections. Approximately 21.1% of A. baumannii strains were resistant to carbapenem. All S. aureus isolates were susceptible to methicillin. CONCLUSIONS Waterborne bacteria should be considered in patients of burns with possible water contact. Empirical broad-spectrum antibiotics should be considered for patients who were hospitalized for severe sepsis, or septic shock with a large burn. Antibiotic treatment should be administered based on the specific pathogens and their detection points.
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Affiliation(s)
- Tzu-Chao Lin
- Department of Internal Medicine, Zuoying Branch of Kaohsiung Armed Forces General Hospital, Kaohsiung, Taiwan; Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Rui-Xin Wu
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Chien Chiu
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Ya-Sung Yang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yi Lee
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Jung-Chung Lin
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Feng-Yee Chang
- Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Pendleton KM, Huffnagle GB, Dickson RP. The significance of Candida in the human respiratory tract: our evolving understanding. Pathog Dis 2017; 75:3102948. [PMID: 28423168 DOI: 10.1093/femspd/ftx029] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 03/12/2017] [Indexed: 02/06/2023] Open
Abstract
Candida is an opportunistic pathogen and the most commonly isolated fungal genus in humans. Though Candida is often detected in respiratory specimens from humans with and without lung disease, its significance remains undetermined. While historically considered a commensal organism with low virulence potential, the status of Candida as an innocent bystander has recently been called into question by both clinical observations and animal experimentation. We here review what is currently known and yet to be determined about the clinical, microbiological and pathophysiological significance of the detection of Candida spp. in the human respiratory tract.
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Affiliation(s)
- Kathryn M Pendleton
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - Gary B Huffnagle
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, USA.,Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor, MI 48109, USA.,Department of Molecular, Cellular, and Developmental Biology, University of Michigan, Ann Arbor, MI 48109, USA.,Mary H. Weiser Food Allergy Center, University of Michigan, Ann Arbor, MI 48109, USA
| | - Robert P Dickson
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan Medical School, Ann Arbor, MI 48109, USA
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21
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Comparative Population Plasma and Tissue Pharmacokinetics of Micafungin in Critically Ill Patients with Severe Burn Injuries and Patients with Complicated Intra-Abdominal Infection. Antimicrob Agents Chemother 2016; 60:5914-21. [PMID: 27458229 DOI: 10.1128/aac.00727-16] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 07/02/2016] [Indexed: 11/20/2022] Open
Abstract
Severely burned patients have altered drug pharmacokinetics (PKs), but it is unclear how different they are from those in other critically ill patient groups. The aim of the present study was to compare the population pharmacokinetics of micafungin in the plasma and burn eschar of severely burned patients with those of micafungin in the plasma and peritoneal fluid of postsurgical critically ill patients with intra-abdominal infection. Fifteen burn patients were compared with 10 patients with intra-abdominal infection; all patients were treated with 100 to 150 mg/day of micafungin. Micafungin concentrations in serial blood, peritoneal fluid, and burn tissue samples were determined and were subjected to a population pharmacokinetic analysis. The probability of target attainment was calculated using area under the concentration-time curve from 0 to 24 h/MIC cutoffs of 285 for Candida parapsilosis and 3,000 for non-parapsilosis Candida spp. by Monte Carlo simulations. Twenty-five patients (18 males; median age, 50 years; age range, 38 to 67 years; median total body surface area burned, 50%; range of total body surface area burned, 35 to 65%) were included. A three-compartment model described the data, and only the rate constant for the drug distribution from the tissue fluid to the central compartment was statistically significantly different between the burn and intra-abdominal infection patients (0.47 ± 0.47 versus 0.15 ± 0.06 h(-1), respectively; P < 0.05). Most patients would achieve plasma PK/pharmacodynamic (PD) targets of 90% for non-parapsilosis Candida spp. and C. parapsilosis with MICs of 0.008 and 0.064 mg/liter, respectively, for doses of 100 mg daily and 150 mg daily. The PKs of micafungin were not significantly different between burn patients and intra-abdominal infection patients. After the first dose, micafungin at 100 mg/day achieved the PK/PD targets in plasma for MIC values of ≤0.008 mg/liter and ≤0.064 mg/liter for non-parapsilosis Candida spp. and Candida parapsilosis species, respectively.
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22
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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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23
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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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24
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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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RELJA B, OMID N, WAGNER N, MÖRS K, WERNER I, JUENGEL E, PERL M, MARZI I. Ethanol, ethyl and sodium pyruvate decrease the inflammatory responses of human lung epithelial cells via Akt and NF-κB in vitro but have a low impact on hepatocellular cells. Int J Mol Med 2015; 37:517-25. [DOI: 10.3892/ijmm.2015.2431] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 12/02/2015] [Indexed: 11/05/2022] Open
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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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Blyth DM, Mende K, Weintrob AC, Beckius ML, Zera WC, Bradley W, Lu D, Tribble DR, Murray CK. Resistance patterns and clinical significance of Candida colonization and infection in combat-related injured patients from iraq and afghanistan. Open Forum Infect Dis 2014; 1:ofu109. [PMID: 25734177 PMCID: PMC4324214 DOI: 10.1093/ofid/ofu109] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 11/12/2014] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Penetrating wounds with environmental contamination are associated with a range of infectious complications, including fungus. This is the first study to examine the epidemiology, resistance patterns, and outcomes of Candida infections and colonization in United States military patients injured in Iraq and Afghanistan. METHODS Clinical information associated with initial unique and serial Candida isolates collected from patients (June 2009-October 2013) through the Trauma Infectious Disease Outcomes Study (TIDOS) was evaluated. Susceptibilities were performed using Sensititre YeastOne (YO-9) plates and interpreted by Clinical Laboratory and Standards Institute (CLSI) and adjusted-European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. RESULTS The analysis included 127 patients with 131 unique Candida isolates, of which 102 were Candida albicans and 29 non-albicans Candida spp. Overall, 99% of patients were male with a median age of 23 and an injury severity score of 22. Injuries were primarily due to blasts (77%) and sustained among personnel serving in Afghanistan (89%). There was a median of 7 days from injury to Candida isolation, and 74 isolates were associated with infection. In the multivariate analysis, non-albicans Candida spp were associated with prior antifungal exposure, blood isolates, and wound isolates (P < .01). Nonsusceptibility by CLSI and EUCAST criteria was associated with non-albicans Candida spp (P < .05). Patients with Candida isolation had a 7.1% mortality rate, compared with 1.4% from the overall TIDOS population. CONCLUSIONS Candida isolation from patients with penetrating war injuries may identify a population at higher risk for death. Prospective studies are needed to determine whether targeted antifungals and surgical management will affect this mortality rate.
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Affiliation(s)
- Dana M. Blyth
- Infectious Disease Service, San Antonio Military Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas
| | - Katrin Mende
- Infectious Disease Service, San Antonio Military Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.
| | - Amy C. Weintrob
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.
- Infectious Disease, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Miriam L. Beckius
- Infectious Disease Service, San Antonio Military Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas
| | - Wendy C. Zera
- Infectious Disease Service, San Antonio Military Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.
| | - William Bradley
- Infectious Disease Service, San Antonio Military Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.
| | - Dan Lu
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.
| | - David R. Tribble
- Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences
| | - Clinton K. Murray
- Infectious Disease Service, San Antonio Military Medical Center, Joint Base San Antonio-Fort Sam Houston, Texas
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Efficacy of Silver-Loaded Nanofiber Dressings in Candida albicans–Contaminated Full-Skin Thickness Rat Burn Wounds. J Burn Care Res 2014; 35:e317-20. [DOI: 10.1097/bcr.0b013e3182aa7143] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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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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Katz T, Wasiak J, Cleland H, Padiglione A. Incidence of non-candidal fungal infections in severe burn injury: an Australian perspective. Burns 2013; 40:881-6. [PMID: 24380706 DOI: 10.1016/j.burns.2013.11.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 11/25/2013] [Accepted: 11/30/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Infection remains the primary cause of morbidity and mortality in the burns patient population. While candidal infection in burns patients is well described, there is dearth of information regarding non-candidal fungal infections in this setting. METHOD All adult burns patients who developed non-candidal fungal infections over a period of 10 years (between January 2001 and June 2011) were included. Retrospective data analyzed included patient demographics, organisms cultured, antibiotic susceptibility patterns, treatment, length of stay and overall mortality. RESULTS The incidence of non-candidal fungal infections at our centre over the time period studied was 0.04%. A total of 12 patients had a fungus other than Candida isolated. Of these 12 patients, seven were thought to have clinically significant fungal infections and were treated with targeted anti-fungal therapy. Between them, seven species of fungus were isolated: Aspergillus fumigatus (n=7), Scedosporium prolificans (n=2), Fusarium solani (n=2), Mucor spp. (n=2), Absydia corymbifera (n=1), Penicillium (n=1) and Alternaria spp. (n=1). Of those definitively treated, two died, although fungal infection was not believed to be a contributing factor to these deaths. CONCLUSION We demonstrate a low incidence and attributable mortality of non-candidal fungal infections in the setting of early antifungal therapy and extensive surgical debridement at our state-wide Burns Service.
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Affiliation(s)
- T Katz
- Victorian Adult Burns Service, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia.
| | - J Wasiak
- Victorian Adult Burns Service and School of Public Health and Preventive Medicine, Monash University, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia.
| | - H Cleland
- Victorian Adult Burns Service and Department of Surgery, Monash University, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia
| | - A Padiglione
- Department of Infectious Diseases, The Alfred Hospital, Commercial Road, Melbourne, Victoria, Australia
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Sasaki J, Matsumoto K, Fujishima S, Morita K, Hori S. Pharmacokinetics of a polyene antifungal agent, liposomal amphotericin B (L-AMB), in a severely burned patient. J Chemother 2013; 26:312-4. [PMID: 24070023 DOI: 10.1179/1973947813y.0000000141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Penetration of micafungin into the burn eschar in patients with severe burns. Eur J Drug Metab Pharmacokinet 2013; 39:93-7. [PMID: 23771854 DOI: 10.1007/s13318-013-0146-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Accepted: 05/31/2013] [Indexed: 10/26/2022]
Abstract
Micafungin (MCFG) concentrations in the plasma and in burn eschar were investigated after daily intravenous infusion (1 h) of MCFG (200 mg) in three patients with severe burns. MCFG treatment was initiated more than 72 h after the burn injuries. The MCFG concentrations in the plasma were determined at the end of the first administration of MCFG, immediately before the second dosing, at the end of the MCFG infusion after at least 4 days from the initial treatment, and immediately before the subsequent dosing using high-performance liquid chromatography. In addition, the trough levels in burn eschar after both the initial administration and repeated administration were measured. The peak and trough levels in the plasma were comparable to or slightly lower than the reported values in healthy volunteers. The mean (range) MCFG concentrations in the burn eschar after initial administration and repeated administration were 1.41 μg/mL (<0.1-3.98 μg/mL) and 6.65 μg/mL (1.10-14.81 μg/mL), respectively. In most cases, the MCFG concentrations in the burn eschar, especially after repeated administration, were higher than the reported MIC90 of MCFG against the clinically important pathogenic species of Candida and Aspergillus. These results suggest that MCFG is capable of penetrating burn eschar.
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Abstract
Like the previous year, 2010 was another active year for research in burn care. For this year, more than 1200 burn-related articles were published on a diverse array of topics. In this review, we focus on innovative and impactful burn injury-related research. As in the previous review, we group articles according to the following categories: critical care, infection, inhalation injury, epidemiology, psychology, wound characterization and treatment, nutrition and metabolism, pain and itch management, burn reconstruction, and rehabilitation. We have found that burn research continues to be prolific throughout the world and reflects the wide-ranging and complex care requirements of burn survivors.
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Trupkovic T, Gille J, Fischer H, Kleinschmidt S. [Antimicrobial treatment in burn injury patients]. Anaesthesist 2012; 61:249-51, 254-6, 258. [PMID: 22430556 DOI: 10.1007/s00101-012-1994-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Infections are a great diagnostic and therapeutic challenge in intensive care patients with burn injuries. The major problems are due to bacteria with hospital-acquired multiresistance to antibiotics but fungal and viral infections may also be life-threatening. The main key points addressing pharmacotherapy with antibiotic, antifungal and antiviral agents in this special setting are exact diagnosis, early therapy with suitable drugs, adequate duration of treatment and adequate doses based on pharmacokinetic and pharmacodynamic characteristics of these compounds. The latter parameters are significantly altered in burn patients and show a wide interindividual and intraindividual variation in drug response as a result of the characteristic phases of burn injury. Drug concentration analysis may help to avoid inadequate dosing. In this review the main characteristics of burn injuries and the pharmacology of antibiotics, antifungal and antiviral agents in these patients are presented.
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Affiliation(s)
- T Trupkovic
- Abteilung für Anästhesie, Intensivmedizin und Schmerztherapie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Deutschland
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Wolf SE, Sterling JP, Hunt JL, Arnoldo BD. The year in burns 2010. Burns 2012; 37:1275-87. [PMID: 22075032 DOI: 10.1016/j.burns.2011.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Accepted: 10/13/2011] [Indexed: 01/08/2023]
Abstract
For 2010, roughly 1446 original burn research articles were published in scientific journals using the English language. This article reviews those with the most impact on burn treatment according to the Editor of one of the major journals (Burns) and his colleagues. As in previous reviews, articles were divided into the following topic areas: epidemiology, demographics of injury, wound characterisation and treatment, critical care, inhalation injury, infection, metabolism and nutrition, psychological considerations, pain and itching management, rehabilitation and long-term outcomes, and burn reconstruction. Each paper is considered very briefly, and the reader is referred to full manuscripts for details.
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Affiliation(s)
- Steven E Wolf
- Division of Burn, Trauma, and Critical Care, Department of Surgery, University of Texas-Southwestern Medical Center, Dallas, TX 75390-9158, United States.
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Micafungin concentrations in the plasma and burn eschar of severely burned patients. Antimicrob Agents Chemother 2011; 56:1113-5. [PMID: 22083486 DOI: 10.1128/aac.05381-11] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Micafungin concentrations in plasma and burn eschar after daily intravenous infusion (1 h) of micafungin (200 to 300 mg) were investigated for six patients with severe burns. Micafungin treatment was initiated more than 72 h after the burn injuries. The peak and trough levels in the plasma after the initial administration and repeated administrations for more than 4 days were comparable with or slightly lower than the reported values for healthy volunteers. Micafungin concentrations in the plasma and burn eschar were between 3.6 and >1,000 times higher than the reported MIC(90)s of micafungin against clinically important Candida and Aspergillus species.
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Comparison of silver-coated dressing (Acticoat®), chlorhexidine acetate 0.5% (Bactigrass®) and nystatin for topical antifungal effect in Candida albicans-contaminated, full-skin-thickness rat burn wounds. Burns 2011; 37:882-5. [DOI: 10.1016/j.burns.2011.01.024] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Revised: 12/10/2010] [Accepted: 01/24/2011] [Indexed: 11/22/2022]
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Shupp JW, Petraitiene R, Jaskille AD, Pavlovich AR, Matt SE, Nguyen DT, Kath MA, Jeng JC, Jordan MH, Finkelman M, Walsh TJ, Shoham S. Early serum (1→3)-β-D-glucan levels in patients with burn injury. Mycoses 2011; 55:224-7. [DOI: 10.1111/j.1439-0507.2011.02068.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Posluszny JA, Conrad P, Halerz M, Shankar R, Gamelli RL. Surgical burn wound infections and their clinical implications. J Burn Care Res 2011; 32:324-33. [PMID: 21252689 DOI: 10.1097/bcr.0b013e31820aaffe] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Typically, burn wound infections are classified by the organisms present in the wound within the first several days after injury or later by routine surveillance cultures. With universal acceptance of early excision and grafting, classification of burn wound colonization in unexcised burn wounds is less relevant, shifting clinical significance to open burn-related surgical wound infections (SWIs). To better characterize SWIs and their clinical relevance, the authors identified the pathogens responsible for SWIs, their impact on rates of regrafting, and the relationship between SWI and nosocomial infection (NI) pathogens. Epidemiologic and clinical data for 71 adult patients with ≥ 20% TBSA burn were collected. After excision and grafting, if a grafted site had clinical characteristics of infection, a wound culture swab was obtained and the organism identified. Surveillance cultures were not obtained. SWI pathogen, anatomic location, postburn day of occurrence, and need for regrafting were compiled. A positive culture obtained from an isolated anatomic location at any time point after excision and grafting of that location was considered a distinct infection. Pathogens responsible for NIs (urinary tract infections, pneumonia, bloodstream and catheter-related bloodstream infections, pseudomembranous colitis, and donor site infections) and their postburn day were identified. The profiles of SWI pathogens and NI pathogens were then compared. Of the 71 patients included, 2 withdrew, 6 had no excision or grafting performed, and 1 had incomplete data. Of the remaining 62 patients, 24 (39%) developed an SWI. In these 24 patients, 70 distinct infections were identified, of which 46% required regrafting. Candida species (24%), Pseudomonas aeruginosa (22%), Serratia marcescens (11%), and Staphylococcus aureus (11%) comprised the majority of pathogens. Development of an SWI with the need for regrafting increased overall length of stay, area of autograft, number of operative events, and was closely associated with the number of NIs. The %TBSA burn and depth of the burn were the main risk factors for SWI with need for regrafting. The SWI pathogen was identified as an NI pathogen 56% of the time, with no temporal correlation between shared SWI and NI pathogens. SWIs are commonly found in severely burned patients and are associated with regrafting. As a result, patients with SWIs are subjected to increased operative events, autograft placement, and increased length of hospitalization. In addition, the presence of an SWI may be a risk factor for development of NIs.
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Affiliation(s)
- Joseph A Posluszny
- Loyola University Medical Center, Burn and Shock Trauma Institute, Maywood, Illinois, USA
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Walraven CJ, Mercier RC, Lee SA. Antifungal Pharmacokinetics and Dosing Considerations in Burn Patients. CURRENT FUNGAL INFECTION REPORTS 2011. [DOI: 10.1007/s12281-011-0047-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
PURPOSE OF REVIEW This review covers candidaemia in numbers, susceptibility issues, host groups, risk factors and outcome. RECENT FINDINGS The incidence of candidaemia has increased over the last decades. Candida glabrata is particularly common in the northern hemisphere and with increasing age whilst the opposite is true for C. parapsilosis, C. glabrata, C. krusei and a number of emerging species are not fully susceptible to azoles. C. parapsilosis and C. guilliermondii are not fully susceptible to echinocandins. Increasing rates of C. parapsilosis have been observed at centres with a high use of echinocandins, and outcome for this species is not superior comparing echinocandins with fluconazole. Acquired azole resistance has recently been described in as many as a third of 19% resistant isolates and echinocandin resistance has emerged and been detected as early as day 12 of echinocandin therapy. ICU stay and abdominal surgery are among the most important risk factors. Outcome is dependent on species involved, timing, dosing and choice of therapy and management of the primary focus of infection. However, host factors are dominating predictors of mortality in recent studies of ICU candidiasis. SUMMARY The changing epidemiology highlights the need for close monitoring of local incidence, species distribution and susceptibility in order to optimize therapy and outcome.
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