Véronique Maurel1, Blandine Denis2, Matthieu Camby1, Mathieu Jeanne3, Aline Cornesse4, Boris Glavnik5, Alexandre Alanio6,7,8, Anne-Françoise Rousseau9, Ronan Lefloch10, Marie Lagrange-Xelot11, Julien Textoris12,13, Sandrine Wiramus14, Christian de Tymowski1, Matthieu Legrand1,8,15. 1. Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, St-Louis Hospital, Paris, France. 2. Department of Infectious Diseases, AP-HP, St-Louis Hospital, Paris, France. 3. Department of Anesthesiology and Intensive Care, CHU Lille, Lille, France. 4. Department of Anesthesiology and Critical Care and Burn Unit, CHU Toulouse, Toulouse, France. 5. Department of Anesthesiology and Critical Care and Burn Unit, Mercy Hospital, Metz, France. 6. Molecular Mycology Unit, Institut Pasteur, CNRS, UMR2000, Paris, France. 7. Laboratoire de Parasitologie-Mycologie, Groupe Hospitalier Saint-Louis-Lariboisière-Fernand-Widal, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France. 8. Sorbonne Paris Cité, Université Paris Diderot, Paris, France. 9. Burn Intensive Center, CHU Sart-Tilman, Liège, Belgium. 10. Burn Intensive Care Unit, CHU Nantes, Nantes, France. 11. Department of Infectious Diseases, CHU Félix Guyon, La Reunion, France. 12. Department of Anesthesiology and Intensive Care, Edouard Herriot Hospital, Hospices Civils de Lyon, Lyon, France. 13. EA7426 P13 "Pathophysiology of Injury-Induced Immunosuppression", Hospices Civils de Lyon, bioMérieux, Université Claude Bernard Lyon-1, Lyon, France. 14. Department of Anesthesiology and Critical Care and Burn Unit, AP-HM, Conception Hospital, Marseille, France. 15. UMR INSERM 942, Institut National de la Santé et de la Recherche Médicale (INSERM), F-CRIN INI-CRCT Network, Paris, France.
Abstract
BACKGROUND: Characteristics and outcome of invasive fungal infection (IFI) in critically ill burn patients have been poorly explored. OBJECTIVES: We report the factors associated with 90-day mortality in a multicentre retrospective European study. PATIENTS/ METHODS: All burn patients with confirmed IFI admitted between 1 January 2010 to 31 December 2015 in 10 centres in France and Belgium were included. RESULTS: Ninety-four patients were enrolled with 110 cases of IFIs: 79 (71.8%) were yeasts IFI and 31 (28.2%) filamentous IFI. Incidence was 1% among admitted patients. The 90-day mortality was 37.2% for all IFIs combined, 52% for filamentous infection and 31.9% for yeast infection. Patients with more than one IFI had a higher 90-day mortality than patients with only one episode (61.5% vs 33.5% (P = .006)). In multivariate analysis, higher Simplified Acute Physiology Score II (OR = 1.05 (95% CI: 1.02-1.09) P = .003), bacterial co-infection (OR = 3.85 (95% CI: 1.23-12.01), P = .014) and use of skin allografts at the time of IFI diagnosis (OR = 3.87 (95% CI: 1.31-11.42), P = .021) were associated with 90-day mortality. CONCLUSIONS: Although rare, invasive fungal infections remain associated with poor outcome in burn patients. Bacterial co-infection and presence of allograft were potentially modifiable factors independently associated with outcome.
BACKGROUND: Characteristics and outcome of invasive fungal infection (IFI) in critically ill burn patients have been poorly explored. OBJECTIVES: We report the factors associated with 90-day mortality in a multicentre retrospective European study. PATIENTS/ METHODS: All burn patients with confirmed IFI admitted between 1 January 2010 to 31 December 2015 in 10 centres in France and Belgium were included. RESULTS: Ninety-four patients were enrolled with 110 cases of IFIs: 79 (71.8%) were yeastsIFI and 31 (28.2%) filamentous IFI. Incidence was 1% among admitted patients. The 90-day mortality was 37.2% for all IFIs combined, 52% for filamentous infection and 31.9% for yeast infection. Patients with more than one IFI had a higher 90-day mortality than patients with only one episode (61.5% vs 33.5% (P = .006)). In multivariate analysis, higher Simplified Acute Physiology Score II (OR = 1.05 (95% CI: 1.02-1.09) P = .003), bacterial co-infection (OR = 3.85 (95% CI: 1.23-12.01), P = .014) and use of skin allografts at the time of IFI diagnosis (OR = 3.87 (95% CI: 1.31-11.42), P = .021) were associated with 90-day mortality. CONCLUSIONS: Although rare, invasive fungal infections remain associated with poor outcome in burn patients. Bacterial co-infection and presence of allograft were potentially modifiable factors independently associated with outcome.
Authors: Dolly K Khona; Sashwati Roy; Subhadip Ghatak; Kaixiang Huang; Gargi Jagdale; Lane A Baker; Chandan K Sen Journal: Bioelectrochemistry Date: 2021-08-04 Impact factor: 5.373