BACKGROUND: In recent years, invasive fungal infections (IFI) have complicated the clinical course of patients with combat-related injuries. Commonalities in injury patterns and characteristics among patients with IFI led to the development of a Joint Trauma System (JTS) clinical practice guideline (CPG) for IFI management. We performed a case-control study to confirm and further delineate risk factors associated with IFI development in combat casualties with the objective of generating data to refine the CPG and promote timelier initiation of treatment. METHODS: Data were collected retrospectively for United States (U.S.) military personnel injured during deployment in Afghanistan from June 2009 through August 2011. Cases were identified as IFI based upon wound cultures with fungal growth and/or fungal elements seen on histology, in addition to the presence of recurrent wound necrosis. Controls were matched using date of injury (±3 mo) and injury severity score (±10). Risk factor parameters analyzed included injury circumstances, blood transfusion requirements, amputations after first operative intervention, and associated injuries. Data are expressed as multivariate odds ratios (OR; 95% confidence interval [CI]). RESULTS: Seventy-six IFI cases were identified from 1,133 U.S. military personnel wounded in Afghanistan and matched to 150 controls. Parameters associated significantly with the development of IFI multivariate analysis were blast injuries (OR: 5.7; CI: 1.1-29.6), dismounted at time of injury (OR: 8.5; CI: 1.2-59.8); above the knee amputations (OR: 4.1; CI: 1.3-12.7), and large-volume packed red blood cell (PRBC; >20 U) transfusions within first 24 h (OR: 7.0; CI: 2.5-19.7). CONCLUSIONS: Our analysis indicates that dismounted blast injuries, resulting in above the knee amputations, and requirement of large volume PRBC transfusions are independent predictors of IFI development. These data confirm all the preliminary risk factors, except for genitalia/perineal injuries, utilized by JTS in their IFI CPG. Model validation is necessary for further risk factor specification.
BACKGROUND: In recent years, invasive fungal infections (IFI) have complicated the clinical course of patients with combat-related injuries. Commonalities in injury patterns and characteristics among patients with IFI led to the development of a Joint Trauma System (JTS) clinical practice guideline (CPG) for IFI management. We performed a case-control study to confirm and further delineate risk factors associated with IFI development in combat casualties with the objective of generating data to refine the CPG and promote timelier initiation of treatment. METHODS: Data were collected retrospectively for United States (U.S.) military personnel injured during deployment in Afghanistan from June 2009 through August 2011. Cases were identified as IFI based upon wound cultures with fungal growth and/or fungal elements seen on histology, in addition to the presence of recurrent wound necrosis. Controls were matched using date of injury (±3 mo) and injury severity score (±10). Risk factor parameters analyzed included injury circumstances, blood transfusion requirements, amputations after first operative intervention, and associated injuries. Data are expressed as multivariate odds ratios (OR; 95% confidence interval [CI]). RESULTS: Seventy-six IFI cases were identified from 1,133 U.S. military personnel wounded in Afghanistan and matched to 150 controls. Parameters associated significantly with the development of IFI multivariate analysis were blast injuries (OR: 5.7; CI: 1.1-29.6), dismounted at time of injury (OR: 8.5; CI: 1.2-59.8); above the knee amputations (OR: 4.1; CI: 1.3-12.7), and large-volume packed red blood cell (PRBC; >20 U) transfusions within first 24 h (OR: 7.0; CI: 2.5-19.7). CONCLUSIONS: Our analysis indicates that dismounted blast injuries, resulting in above the knee amputations, and requirement of large volume PRBC transfusions are independent predictors of IFI development. These data confirm all the preliminary risk factors, except for genitalia/perineal injuries, utilized by JTS in their IFI CPG. Model validation is necessary for further risk factor specification.
Authors: Bradley Lloyd; Amy C Weintrob; Carlos Rodriguez; James R Dunne; Allison B Weisbrod; Mary Hinkle; Tyler Warkentien; Clinton K Murray; John Oh; Eugene V Millar; Jinesh Shah; Faraz Shaikh; Stacie Gregg; Gina Lloyd; Julie Stevens; M Leigh Carson; Deepak Aggarwal; David R Tribble Journal: Surg Infect (Larchmt) Date: 2014-05-13 Impact factor: 2.150
Authors: James R Dunne; Jason S Hawksworth; Alexander Stojadinovic; Fred Gage; Doug K Tadaki; Philip W Perdue; Jonathan Forsberg; Tom Davis; John W Denobile; Trevor S Brown; Eric A Elster Journal: J Trauma Date: 2009-04
Authors: Robyn Neblett Fanfair; Kaitlin Benedict; John Bos; Sarah D Bennett; Yi-Chun Lo; Tolu Adebanjo; Kizee Etienne; Eszter Deak; Gordana Derado; Wun-Ju Shieh; Clifton Drew; Sherif Zaki; David Sugerman; Lalitha Gade; Elizabeth H Thompson; Deanna A Sutton; David M Engelthaler; James M Schupp; Mary E Brandt; Julie R Harris; Shawn R Lockhart; George Turabelidze; Benjamin J Park Journal: N Engl J Med Date: 2012-12-06 Impact factor: 91.245
Authors: Grant V Bochicchio; Lena Napolitano; Manjari Joshi; Kelly Bochicchio; Walter Meyer; Thomas M Scalea Journal: World J Surg Date: 2008-10 Impact factor: 3.352
Authors: Ben De Pauw; Thomas J Walsh; J Peter Donnelly; David A Stevens; John E Edwards; Thierry Calandra; Peter G Pappas; Johan Maertens; Olivier Lortholary; Carol A Kauffman; David W Denning; Thomas F Patterson; Georg Maschmeyer; Jacques Bille; William E Dismukes; Raoul Herbrecht; William W Hope; Christopher C Kibbler; Bart Jan Kullberg; Kieren A Marr; Patricia Muñoz; Frank C Odds; John R Perfect; Angela Restrepo; Markus Ruhnke; Brahm H Segal; Jack D Sobel; Tania C Sorrell; Claudio Viscoli; John R Wingard; Theoklis Zaoutis; John E Bennett Journal: Clin Infect Dis Date: 2008-06-15 Impact factor: 9.079
Authors: Aaron R Farmer; Clinton K Murray; Ian R Driscoll; Brian L Wickes; Nathan Wiederhold; Deanna A Sutton; Carmita Sanders; Katrin Mende; Brent Enniss; James Feig; Anuradha Ganesan; Elizabeth A Rini; Todd J Vento Journal: J Clin Microbiol Date: 2015-04-01 Impact factor: 5.948
Authors: Anuradha Ganesan; Justin Wells; Faraz Shaikh; Philip Peterson; William Bradley; M Leigh Carson; Joseph L Petfield; Mary Klassen-Fischer; Kevin S Akers; Kevin Downing; Ralf Bialek; David R Tribble; Brian L Wickes Journal: J Clin Microbiol Date: 2019-12-23 Impact factor: 5.948
Authors: Tyler E Warkentien; Faraz Shaikh; Amy C Weintrob; Carlos J Rodriguez; Clinton K Murray; Bradley A Lloyd; Anuradha Ganesan; Deepak Aggarwal; M Leigh Carson; David R Tribble Journal: J Clin Microbiol Date: 2015-05-13 Impact factor: 5.948
Authors: Stephen Y Liang; Brendan Jackson; Janis Kuhn; Faraz Shaikh; Dana M Blyth; Timothy J Whitman; Joseph L Petfield; M Leigh Carson; David R Tribble; Jay R McDonald Journal: Surg Infect (Larchmt) Date: 2019-05-21 Impact factor: 2.150
Authors: David R Tribble; Clinton K Murray; Bradley A Lloyd; Anuradha Ganesan; Katrin Mende; Dana M Blyth; Joseph L Petfield; Jay McDonald Journal: Mil Med Date: 2019-11-01 Impact factor: 1.437
Authors: David R Tribble; Ping Li; Tyler E Warkentien; Bradley A Lloyd; Elizabeth R Schnaubelt; Anuradha Ganesan; William Bradley; Deepak Aggarwal; M Leigh Carson; Amy C Weintrob; Clinton K Murray Journal: Mil Med Date: 2016-10 Impact factor: 1.437
Authors: Carlos Rodriguez; Amy C Weintrob; James R Dunne; Allison B Weisbrod; Bradley Lloyd; Tyler Warkentien; Debra Malone; Justin Wells; Clinton K Murray; William Bradley; Faraz Shaikh; Jinesh Shah; Michelle Leigh Carson; Deepak Aggarwal; David R Tribble Journal: J Trauma Acute Care Surg Date: 2014-11 Impact factor: 3.313
Authors: Louis R Lewandowski; Amy C Weintrob; David R Tribble; Carlos J Rodriguez; Joseph Petfield; Bradley A Lloyd; Clinton K Murray; Daniel Stinner; Deepak Aggarwal; Faraz Shaikh; Benjamin K Potter Journal: J Orthop Trauma Date: 2016-03 Impact factor: 2.512