BACKGROUND: An outbreak of invasive fungal infections (IFI) began in 2009 among United States servicemen who sustained blast injuries in Afghanistan. In response, the military trauma community sought a uniform approach to early diagnosis and treatment. Toward this goal, a local clinical practice guideline (CPG) was implemented at Landstuhl Regional Medical Center (LRMC) in early 2011 to screen for IFI in high-risk patients using tissue histopathology and fungal cultures. METHODS: We compared IFI cases identified after initiation of the CPG (February through August 2011) to cases from a pre-CPG period (June 2009 through January 2011). RESULTS: Sixty-one patients were screened in the CPG period, among whom 30 IFI cases were identified and compared with 44 pre-CPG IFI cases. Demographics between the two study periods were similar, although significantly higher transfusion requirements (p<0.05) and non-significant trends in injury severity scores and early lower extremity amputation rates suggested more severe injuries in CPG-period cases. Pre-CPG IFI cases were more likely to be associated with angioinvasion on histopathology than CPG IFI cases (48% versus 17%; p<0.001). Time to IFI diagnosis (three versus nine days) and to initiation of antifungal therapy (seven versus 14 days) were significantly decreased in the CPG period (p<0.001). Additionally, more IFI patients received antifungal agent at LRMC during the CPG period (30%) versus pre-CPG period (5%; p=0.005). The CPG IFI cases were also prescribed more commonly dual antifungal therapy (73% versus 36%; p=0.002). There was no statistical difference in length of stay or mortality between pre-CPG and CPG IFI cases; although a non-significant reduction in crude mortality from 11.4% to 6.7% was observed. CONCLUSIONS: Angioinvasive IFI as a percentage of total IFI cases decreased during the CPG period. Earlier diagnosis and commencement of more timely treatment was achieved. Despite these improvements, no difference in clinical outcomes was observed compared with the pre-CPG period.
BACKGROUND: An outbreak of invasive fungal infections (IFI) began in 2009 among United States servicemen who sustained blast injuries in Afghanistan. In response, the military trauma community sought a uniform approach to early diagnosis and treatment. Toward this goal, a local clinical practice guideline (CPG) was implemented at Landstuhl Regional Medical Center (LRMC) in early 2011 to screen for IFI in high-risk patients using tissue histopathology and fungal cultures. METHODS: We compared IFI cases identified after initiation of the CPG (February through August 2011) to cases from a pre-CPG period (June 2009 through January 2011). RESULTS: Sixty-one patients were screened in the CPG period, among whom 30 IFI cases were identified and compared with 44 pre-CPG IFI cases. Demographics between the two study periods were similar, although significantly higher transfusion requirements (p<0.05) and non-significant trends in injury severity scores and early lower extremity amputation rates suggested more severe injuries in CPG-period cases. Pre-CPG IFI cases were more likely to be associated with angioinvasion on histopathology than CPG IFI cases (48% versus 17%; p<0.001). Time to IFI diagnosis (three versus nine days) and to initiation of antifungal therapy (seven versus 14 days) were significantly decreased in the CPG period (p<0.001). Additionally, more IFI patients received antifungal agent at LRMC during the CPG period (30%) versus pre-CPG period (5%; p=0.005). The CPG IFI cases were also prescribed more commonly dual antifungal therapy (73% versus 36%; p=0.002). There was no statistical difference in length of stay or mortality between pre-CPG and CPG IFI cases; although a non-significant reduction in crude mortality from 11.4% to 6.7% was observed. CONCLUSIONS: Angioinvasive IFI as a percentage of total IFI cases decreased during the CPG period. Earlier diagnosis and commencement of more timely treatment was achieved. Despite these improvements, no difference in clinical outcomes was observed compared with the pre-CPG period.
Authors: Maureen M Roden; Theoklis E Zaoutis; Wendy L Buchanan; Tena A Knudsen; Tatyana A Sarkisova; Robert L Schaufele; Michael Sein; Tin Sein; Christine C Chiou; Jaclyn H Chu; Dimitrios P Kontoyiannis; Thomas J Walsh Journal: Clin Infect Dis Date: 2005-07-29 Impact factor: 9.079
Authors: Robert W Taylor; Jacklyn O'Brien; Steven J Trottier; Lisa Manganaro; Margaret Cytron; Mary F Lesko; Kimberly Arnzen; Carla Cappadoro; Min Fu; Michael S Plisco; Farid G Sadaka; Christopher Veremakis Journal: Crit Care Med Date: 2006-09 Impact factor: 7.598
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: 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: 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: 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: Joseph M Yabes; Brian K White; Clinton K Murray; Carlos J Sanchez; Katrin Mende; Miriam L Beckius; Wendy C Zera; Joseph C Wenke; Kevin S Akers Journal: Med Mycol Date: 2017-04-01 Impact factor: 4.076
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
Authors: Carlos J Rodriguez; Amy C Weintrob; Jinesh Shah; Debra Malone; James R Dunne; Allison B Weisbrod; Bradley A Lloyd; Tyler E Warkentien; Clinton K Murray; Kenneth Wilkins; Faraz Shaikh; M Leigh Carson; Deepak Aggarwal; David R Tribble Journal: Surg Infect (Larchmt) Date: 2014-05-12 Impact factor: 2.150