Classification of Trauma-Associated Invasive Fungal Infections to Support Wound Treatment Decisions

Autor: M. Leigh Carson, Joseph L Petfield, William E. Bradley, Denise Bennett, Justin Wells, Anuradha Ganesan, Faraz Shaikh, David R. Tribble, Dana M Blyth
Rok vydání: 2019
Předmět:
blast wound
Microbiology (medical)
Antifungal
Mucorales
medicine.medical_specialty
Necrosis
Epidemiology
medicine.drug_class
030231 tropical medicine
lcsh:Medicine
Classification of Trauma-Associated Invasive Fungal Infections to Support Wound Treatment Decisions
mucormycosis
lcsh:Infectious and parasitic diseases
03 medical and health sciences
0302 clinical medicine
Fusarium
Internal medicine
medicine
Humans
Localized infection
lcsh:RC109-216
030212 general & internal medicine
bacteria
Wound treatment
invasive fungal infections
Afghan Campaign 2001
integumentary system
biology
Multiple Trauma
business.industry
lcsh:R
Mucormycosis
Afghanistan
Service member
Decision Support Systems
Clinical
medicine.disease
biology.organism_classification
United States
Aspergillus
Military Personnel
trauma
Infectious Diseases
ORDER MUCORALES
Synopsis
wound infection
fungi
medicine.symptom
business
Zdroj: Emerging Infectious Diseases, Vol 25, Iss 9, Pp 1639-1647 (2019)
Emerging Infectious Diseases
ISSN: 1080-6059
1080-6040
DOI: 10.3201/eid2509.190168
Popis: The proposed classification, based on diagnostic certainty, provides a framework for determining initial empiric and subsequent targeted therapy.
To evaluate a classification system to support clinical decisions for treatment of contaminated deep wounds at risk for an invasive fungal infection (IFI), we studied 246 US service members (413 wounds) injured in Afghanistan (2009–2014) who had laboratory evidence of fungal infection. A total of 143 wounds with persistent necrosis and laboratory evidence were classified as IFI; 120 wounds not meeting IFI criteria were classified as high suspicion (patients had localized infection signs/symptoms and had received antifungal medication for >10 days), and 150 were classified as low suspicion (failed to meet these criteria). IFI patients received more blood than other patients and had more severe injuries than patients in the low-suspicion group. Fungi of the order Mucorales were more frequently isolated from IFI (39%) and high-suspicion (21%) wounds than from low-suspicion (9%) wounds. Wounds that did not require immediate antifungal therapy lacked necrosis and localized signs/symptoms of infection and contained fungi from orders other than Mucorales.
Databáze: OpenAIRE
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