Fungal wound infection (not colonization) is independently associated with mortality in burn patients

Edward E. Horvath, Clinton K. Murray, George M. Vaughan, Kevin K. Chung, Duane R. Hospenthal, Charles E. Wade, John B. Holcomb, Steven Wolf, Arthur D. Mason, Leopoldo C. Cancio

Research output: Contribution to journalArticle

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Abstract

OBJECTIVE: To analyze the occurrence of fungal wound infection (FWI) after thermal injury and its relationship to mortality. BACKGROUND: FWI is an uncommon but potentially lethal complication of severe thermal injury. METHODS: The records of patients with thermal burns admitted to a single burn center (1991-2002) were reviewed. Analyses accounted for total burn size (TBS, percentage body surface area), full-thickness burn size (FTBS, percentage body surface area), age, inhalation injury, sex, and fungal-status category. Fungal colonization and infection were determined histopathologically. RESULTS: Criteria for inclusion were met by 2651 patients. Each patient's fungal-status category was defined according to the deepest level of fungal involvement observed during the hospital course: no fungus (2476 patients), fungal wound colonization (FWC, 121 patients), or fungal wound infection (FWI, 54 patients). Median TBS (9%, 47%, 64%, respectively) and mortality (5%, 27%, 76%, respectively) varied significantly among fungal-status groups. Logistic regression was used to detect significant independent associations. FWI was associated with higher TBS. Mortality was associated with TBS, FTBS, inhalation injury, FWI, and age. Unlike FWI, FWC was not independently related to mortality, the greater observed mortality in FWC being explained by other variables such as TBS. The odds ratio for FWI (8.16) suggested about the same mortality impact as augmenting TBS by 33%. A midrange TBS of 30% to 60% was required for most of the detectable association of FWI with mortality. CONCLUSIONS: FWI accompanies larger burns and is associated with mortality in burn patients, particularly in those with TBS 30% to 60%. This association is independent of burn size, inhalation injury, and age.

Original languageEnglish (US)
Pages (from-to)978-985
Number of pages8
JournalAnnals of Surgery
Volume245
Issue number6
DOIs
StatePublished - Jun 1 2007
Externally publishedYes

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Mycoses
Wound Infection
Mortality
Wounds and Injuries
Hot Temperature
Body Surface Area
Burns
Inhalation
Inhalation Burns
Burn Units
Fungi
Logistic Models
Odds Ratio

ASJC Scopus subject areas

  • Surgery

Cite this

Horvath, E. E., Murray, C. K., Vaughan, G. M., Chung, K. K., Hospenthal, D. R., Wade, C. E., ... Cancio, L. C. (2007). Fungal wound infection (not colonization) is independently associated with mortality in burn patients. Annals of Surgery, 245(6), 978-985. https://doi.org/10.1097/01.sla.0000256914.16754.80

Fungal wound infection (not colonization) is independently associated with mortality in burn patients. / Horvath, Edward E.; Murray, Clinton K.; Vaughan, George M.; Chung, Kevin K.; Hospenthal, Duane R.; Wade, Charles E.; Holcomb, John B.; Wolf, Steven; Mason, Arthur D.; Cancio, Leopoldo C.

In: Annals of Surgery, Vol. 245, No. 6, 01.06.2007, p. 978-985.

Research output: Contribution to journalArticle

Horvath, EE, Murray, CK, Vaughan, GM, Chung, KK, Hospenthal, DR, Wade, CE, Holcomb, JB, Wolf, S, Mason, AD & Cancio, LC 2007, 'Fungal wound infection (not colonization) is independently associated with mortality in burn patients', Annals of Surgery, vol. 245, no. 6, pp. 978-985. https://doi.org/10.1097/01.sla.0000256914.16754.80
Horvath, Edward E. ; Murray, Clinton K. ; Vaughan, George M. ; Chung, Kevin K. ; Hospenthal, Duane R. ; Wade, Charles E. ; Holcomb, John B. ; Wolf, Steven ; Mason, Arthur D. ; Cancio, Leopoldo C. / Fungal wound infection (not colonization) is independently associated with mortality in burn patients. In: Annals of Surgery. 2007 ; Vol. 245, No. 6. pp. 978-985.
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abstract = "OBJECTIVE: To analyze the occurrence of fungal wound infection (FWI) after thermal injury and its relationship to mortality. BACKGROUND: FWI is an uncommon but potentially lethal complication of severe thermal injury. METHODS: The records of patients with thermal burns admitted to a single burn center (1991-2002) were reviewed. Analyses accounted for total burn size (TBS, percentage body surface area), full-thickness burn size (FTBS, percentage body surface area), age, inhalation injury, sex, and fungal-status category. Fungal colonization and infection were determined histopathologically. RESULTS: Criteria for inclusion were met by 2651 patients. Each patient's fungal-status category was defined according to the deepest level of fungal involvement observed during the hospital course: no fungus (2476 patients), fungal wound colonization (FWC, 121 patients), or fungal wound infection (FWI, 54 patients). Median TBS (9{\%}, 47{\%}, 64{\%}, respectively) and mortality (5{\%}, 27{\%}, 76{\%}, respectively) varied significantly among fungal-status groups. Logistic regression was used to detect significant independent associations. FWI was associated with higher TBS. Mortality was associated with TBS, FTBS, inhalation injury, FWI, and age. Unlike FWI, FWC was not independently related to mortality, the greater observed mortality in FWC being explained by other variables such as TBS. The odds ratio for FWI (8.16) suggested about the same mortality impact as augmenting TBS by 33{\%}. A midrange TBS of 30{\%} to 60{\%} was required for most of the detectable association of FWI with mortality. CONCLUSIONS: FWI accompanies larger burns and is associated with mortality in burn patients, particularly in those with TBS 30{\%} to 60{\%}. This association is independent of burn size, inhalation injury, and age.",
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T1 - Fungal wound infection (not colonization) is independently associated with mortality in burn patients

AU - Horvath, Edward E.

AU - Murray, Clinton K.

AU - Vaughan, George M.

AU - Chung, Kevin K.

AU - Hospenthal, Duane R.

AU - Wade, Charles E.

AU - Holcomb, John B.

AU - Wolf, Steven

AU - Mason, Arthur D.

AU - Cancio, Leopoldo C.

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Y1 - 2007/6/1

N2 - OBJECTIVE: To analyze the occurrence of fungal wound infection (FWI) after thermal injury and its relationship to mortality. BACKGROUND: FWI is an uncommon but potentially lethal complication of severe thermal injury. METHODS: The records of patients with thermal burns admitted to a single burn center (1991-2002) were reviewed. Analyses accounted for total burn size (TBS, percentage body surface area), full-thickness burn size (FTBS, percentage body surface area), age, inhalation injury, sex, and fungal-status category. Fungal colonization and infection were determined histopathologically. RESULTS: Criteria for inclusion were met by 2651 patients. Each patient's fungal-status category was defined according to the deepest level of fungal involvement observed during the hospital course: no fungus (2476 patients), fungal wound colonization (FWC, 121 patients), or fungal wound infection (FWI, 54 patients). Median TBS (9%, 47%, 64%, respectively) and mortality (5%, 27%, 76%, respectively) varied significantly among fungal-status groups. Logistic regression was used to detect significant independent associations. FWI was associated with higher TBS. Mortality was associated with TBS, FTBS, inhalation injury, FWI, and age. Unlike FWI, FWC was not independently related to mortality, the greater observed mortality in FWC being explained by other variables such as TBS. The odds ratio for FWI (8.16) suggested about the same mortality impact as augmenting TBS by 33%. A midrange TBS of 30% to 60% was required for most of the detectable association of FWI with mortality. CONCLUSIONS: FWI accompanies larger burns and is associated with mortality in burn patients, particularly in those with TBS 30% to 60%. This association is independent of burn size, inhalation injury, and age.

AB - OBJECTIVE: To analyze the occurrence of fungal wound infection (FWI) after thermal injury and its relationship to mortality. BACKGROUND: FWI is an uncommon but potentially lethal complication of severe thermal injury. METHODS: The records of patients with thermal burns admitted to a single burn center (1991-2002) were reviewed. Analyses accounted for total burn size (TBS, percentage body surface area), full-thickness burn size (FTBS, percentage body surface area), age, inhalation injury, sex, and fungal-status category. Fungal colonization and infection were determined histopathologically. RESULTS: Criteria for inclusion were met by 2651 patients. Each patient's fungal-status category was defined according to the deepest level of fungal involvement observed during the hospital course: no fungus (2476 patients), fungal wound colonization (FWC, 121 patients), or fungal wound infection (FWI, 54 patients). Median TBS (9%, 47%, 64%, respectively) and mortality (5%, 27%, 76%, respectively) varied significantly among fungal-status groups. Logistic regression was used to detect significant independent associations. FWI was associated with higher TBS. Mortality was associated with TBS, FTBS, inhalation injury, FWI, and age. Unlike FWI, FWC was not independently related to mortality, the greater observed mortality in FWC being explained by other variables such as TBS. The odds ratio for FWI (8.16) suggested about the same mortality impact as augmenting TBS by 33%. A midrange TBS of 30% to 60% was required for most of the detectable association of FWI with mortality. CONCLUSIONS: FWI accompanies larger burns and is associated with mortality in burn patients, particularly in those with TBS 30% to 60%. This association is independent of burn size, inhalation injury, and age.

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