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Candida: A Decreasing Problem for the Burned Patient?

Candida: A Decreasing Problem for the Burned Patient? Abstract • Multiple recent reports have suggested that Candida wound infection and sepsis are major complications of severe burn injury. Our current burn treatment plans include aggressive early burn excision and grafting, avoidance of invasive monitoring and central hyperalimentation lines, enteral nystatin, and judicious use of antibiotics. A retrospective review of 168 severely burned patients admitted to the Intensive Care Unit of the University of Washington Burn Center, Seattle, during the 18-month period from June 1984 through December 1985 was undertaken. Thirteen percent of these patients had one or more cultures positive for Candida from any site. Three patients (1.8%) developed Candida sepsis, which was diagnosed on the basis of clinical signs of sepsis, a positive blood culture for Candida, and at least two additional culture sites positive for Candida. All three patients were treated with amphotericin B. One of these patients died of Candida sepsis, for an overall mortality of 0.6%. Therefore, Candida septicemia was not a major cause of morbidity or mortality in our burn patients in the Intensive Care Unit during this 18-month period under the current management regimen. (Arch Surg 1988;123:194-196) References 1. Spebar MJ, Walters MJ, Pruitt BA: Improved survival with aggressive surgical management of noncandidal fungal infections of the burn wound . J Trauma 1982;22:867-868.Crossref 2. Pensler JM, Herndon DN, Ptak H, et al: Fungal sepsis: An increasing problem in major thermal injuries . J Burn Care Rehab 1986;7:488-491.Crossref 3. Spebar MJ, Pruitt BA: Candidiasis in the burned patient . J Trauma 1981;21:237-239.Crossref 4. Prasad JK, Feller IF, Thomson PD: A ten year review of Candida sepsis and mortality in burn patients . Surgery 1987;101:213-216. 5. Zapata-Sirvent RL, Wang XW, Miller G, et al: Candida infection in severe burns . Burns 1985;11:330-336.Crossref 6. Zanini V, Viviani MA, Cava L, et al: Candida infections in the burn patients . Pan Med 1983;25:163-166. 7. Desai MH, Herndon DN, Abston S: Candida infection in the massively burned patient. Program and Abstracts of the 18th Annual Meeting of the American Burn Association, Chicago, April 11, 1986. 8. Seeling MS: The role of antibiotics in the pathogenesis of Candida infection . Am J Med 1966;40:887-892.Crossref 9. Rose HD: Venous catheter—associated candidemia . Am J Med Sci 1978;275:265-269.Crossref 10. Brennan MF, Goldman MJ, O'Connell RC, et al: Prolonged parenteral administration: Candida growth and the prevention of candidemia by amphotericin instillation . Ann Surg 1972;176:265-271.Crossref 11. Desai MH, Herndon DN: Eradication of Candida burn wound septicemia in massively burned patients. Program and Abstracts of the 19th Annual Meeting of the American Burn Association, Washington, DC, April 30, 1987. 12. Boileau MA, Grube BJ, Heimbach DM: The management of burns to perineum and genitals. Program and Abstracts of the 19th Annual Meeting of the American Burn Association, Washington, DC, May 1, 1987. 13. Stone HH, Kolb LD, Hoover MB, et al: Candida sepsis: Portals for invasion, tissue filtration, and principles of treatment . Bull de la Societe Internationale de Chirugie 1975;3:193-195. 14. Marvin JA, Roueche AC, Lee JA, et al: Comparison of burn unit microbial colonization before and after two efforts to improve isolation techniques. Program and Abstracts of the 18th Annual Meeting of the American Burn Association, Chicago, April 10, 1986. 15. Pruitt BA, McManus AT: Opportunistic infections in severely burned patients . Am J Med 1984;3:146-154.Crossref 16. McManus AT, McManus WF, Mason AD, et al: Microbial colonization in a new intensive care burn unit . Arch Surg 1985;120:217-223.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

Candida: A Decreasing Problem for the Burned Patient?

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References (13)

Publisher
American Medical Association
Copyright
Copyright © 1988 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1988.01400260078009
Publisher site
See Article on Publisher Site

Abstract

Abstract • Multiple recent reports have suggested that Candida wound infection and sepsis are major complications of severe burn injury. Our current burn treatment plans include aggressive early burn excision and grafting, avoidance of invasive monitoring and central hyperalimentation lines, enteral nystatin, and judicious use of antibiotics. A retrospective review of 168 severely burned patients admitted to the Intensive Care Unit of the University of Washington Burn Center, Seattle, during the 18-month period from June 1984 through December 1985 was undertaken. Thirteen percent of these patients had one or more cultures positive for Candida from any site. Three patients (1.8%) developed Candida sepsis, which was diagnosed on the basis of clinical signs of sepsis, a positive blood culture for Candida, and at least two additional culture sites positive for Candida. All three patients were treated with amphotericin B. One of these patients died of Candida sepsis, for an overall mortality of 0.6%. Therefore, Candida septicemia was not a major cause of morbidity or mortality in our burn patients in the Intensive Care Unit during this 18-month period under the current management regimen. (Arch Surg 1988;123:194-196) References 1. Spebar MJ, Walters MJ, Pruitt BA: Improved survival with aggressive surgical management of noncandidal fungal infections of the burn wound . J Trauma 1982;22:867-868.Crossref 2. Pensler JM, Herndon DN, Ptak H, et al: Fungal sepsis: An increasing problem in major thermal injuries . J Burn Care Rehab 1986;7:488-491.Crossref 3. Spebar MJ, Pruitt BA: Candidiasis in the burned patient . J Trauma 1981;21:237-239.Crossref 4. Prasad JK, Feller IF, Thomson PD: A ten year review of Candida sepsis and mortality in burn patients . Surgery 1987;101:213-216. 5. Zapata-Sirvent RL, Wang XW, Miller G, et al: Candida infection in severe burns . Burns 1985;11:330-336.Crossref 6. Zanini V, Viviani MA, Cava L, et al: Candida infections in the burn patients . Pan Med 1983;25:163-166. 7. Desai MH, Herndon DN, Abston S: Candida infection in the massively burned patient. Program and Abstracts of the 18th Annual Meeting of the American Burn Association, Chicago, April 11, 1986. 8. Seeling MS: The role of antibiotics in the pathogenesis of Candida infection . Am J Med 1966;40:887-892.Crossref 9. Rose HD: Venous catheter—associated candidemia . Am J Med Sci 1978;275:265-269.Crossref 10. Brennan MF, Goldman MJ, O'Connell RC, et al: Prolonged parenteral administration: Candida growth and the prevention of candidemia by amphotericin instillation . Ann Surg 1972;176:265-271.Crossref 11. Desai MH, Herndon DN: Eradication of Candida burn wound septicemia in massively burned patients. Program and Abstracts of the 19th Annual Meeting of the American Burn Association, Washington, DC, April 30, 1987. 12. Boileau MA, Grube BJ, Heimbach DM: The management of burns to perineum and genitals. Program and Abstracts of the 19th Annual Meeting of the American Burn Association, Washington, DC, May 1, 1987. 13. Stone HH, Kolb LD, Hoover MB, et al: Candida sepsis: Portals for invasion, tissue filtration, and principles of treatment . Bull de la Societe Internationale de Chirugie 1975;3:193-195. 14. Marvin JA, Roueche AC, Lee JA, et al: Comparison of burn unit microbial colonization before and after two efforts to improve isolation techniques. Program and Abstracts of the 18th Annual Meeting of the American Burn Association, Chicago, April 10, 1986. 15. Pruitt BA, McManus AT: Opportunistic infections in severely burned patients . Am J Med 1984;3:146-154.Crossref 16. McManus AT, McManus WF, Mason AD, et al: Microbial colonization in a new intensive care burn unit . Arch Surg 1985;120:217-223.Crossref

Journal

Archives of SurgeryAmerican Medical Association

Published: Feb 1, 1988

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