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REFERENCES

10 years of Non-Candidal Mycoses at a State-Wide Burns Service Tanya Katz, Jason Wasiak, Alex Padiglione and Heather Cleland

Victorian Adult Burns Service & The Alfred Hospital, Melbourne VIC

Infection remains the primary cause of morbidity and

mortality in the burns patient population. While candidal

infection in burns patients is well described, there is dearth

of information regarding non-candidal fungal infections in

this setting. Identification of non-candidal fungal infections in

burns patients requires clinical suspicion (especially

consideration of burn injury environment) alongside

microbiological confirmation. Although uncommon, fungal

infections have the potential to cause detrimental outcomes

in burns patients.

The purpose of this study was to review and analyse the

incidence, treatment and outcomes of a cohort of burns

patients with non-candidal fungal infections at our state-

wide Burns Service.

INTRODUCTION

MAIN FINDINGS

Table 1. Baseline demographics and burn injury characteristics of 12 patients reviewed with a non-candidal fungal isolate,

including relevant treatment regimes.

Figure 1. Patients with non-candidal fungal isolates & associated outcomes.

METHODS

Setting : The Victorian Adult Burns Service (VABS) is the

state-wide adult burns service, located at The Alfred

Hospital, which is one of two designated major trauma

services for adults in the state. VABS treats ~250 patients

with acute burn injuries each year.

Data Collection: A retrospective review was performed of all

adult burns patients who developed non-candidal mycoses

over a period of 10 years (between January 2001-June

2011). Data analysed included patient demographics,

organisms cultured, antibiotic susceptibility patterns,

treatment, length of stay and overall mortality. Superficial

non-invasive fungal conditions such as dermatophytoses

were excluded.

OUTCOMES

Pt

Age

Sex

% TBSA

% FTSA

Species

Days to Isolate

Sites

Pathogenic

Co-existing pathogens

Fungal treatment

Survival

1 21 M 78 70 Aspergillus fumigatus

8 Sputum Y C albicans Itraconazole

Y

2 47 M 15 0 Aspergillus fumigatus

11 Sputum N Yeast NIL Y

3 78 F 40 40 Aspergillus fumigatus Scedosporium prolificans

21 Sputum

Sputum

Y P aeruginosa Voriconazole/ Terbinafine

Y

4 31 M 70 15 Aspergillus fumigatus

2 Sputum Y GPC/GNR/GPR Voriconazole

Y

5 57 M 65 40 Mucor ramosissimus Scedosporium prolificans

30 Wound

Sputum

Y S maltophilia K pneumoniae P aeruginosa C albicans

1. Ambisone (Mucor) 2. Voriconazole/Terbinafine (Scedosporium)

N

6 38 M 70 70 Absidia corymbifera

18 Wound Y Yeast E cloacae Enterococcus E coli S maltophilia S Aureus

Ambisone

Y

7 65 M 40 40 Aspergillus fumigatus Col 1+2

7 Sputum Wound

Y P aeruginosa C albicans S maltophilia

1. Voriconazole > Side effect: ARF 2. Ambisone

N

8 42 M 30 20 Mucor spp Penicillium spp

13 Wound Wound

Y A hydrophila K pneumoniae C albicans S maltophilia A baumanii

Ambisone

Y

9 24 M 3 3 Aspergillus fumigatus

14 Wound N Yeast NIL Y

10 36 F 55 6 Fusarium solani

13 Wound Y E cloacae H influenza Yeast S maltophilia

1. Voriconazole > Side effect:

hallucinations

2. Ambisone Isolate recurrence 3. Ambisone

Y

11 63 M 40 40 Aspergillus fumigatus Alternaria spp

3 Sputum Wound

N K pneumoniae E cloacae H Influenza

NIL N

12 49 M 22 4 Fusarium spp 10 Wound N S Aureus P aeruginosa

NIL Y

Secondary review

Treated (n=8)

Not treated (n=4)

Initial management

Total patients with non-candidal fungal isolates (n=12)

Positive Outcome

(n=9)

Death**

(n=3)

Sepsis NOT fungaemia

(n=2)

Full treatment course (n=5)

Treatment ceased* (n=1)

Treatment continued

(n=7)

* Clinically not significant; treatment ceased within 1 week

** No deaths attributable to fungal infection

RESULTS

In conclusion, we emphasize the importance of early burn

wound closure, frequent microbiologic assessment of

burn wounds and aggressive surgical burn wound

excision, together with targeted antifungal agents.

Indications and timing of fungal infection treatment remain

uncertain; frequent review and consultation with infectious

diseases experts is required. Our review illustrates the

low incidence and attributable mortality associated with

non-candidal fungal infections in a modern burns unit.

CONCLUSIONS NON-CANDIDAL FUNGAL INFECTIONS ARE RARE:

Only twelve cases (0.4%) of total 3340 burns patients

MOST COMMON (non-Candidal) FUNGAL SPECIES: Aspergillus (n=7) Fusarium (n=2)

Scedosporium (n=2) Mucor (n=2)

CONCOMINANT INFECTIONS:

Bacterial: 75% (n=9)

Yeast: 67% (n=8)

LOW MORBIDITY

NO ATTRIBUTABLE MORTALITY