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Fungal Burn Wound Infection: A 10-Year Experience

Fungal Burn Wound Infection: A 10-Year Experience Abstract • To evaluate our experience with fungal burn wound infection, we performed a 10-year review for comparison with our experience with bacterial burn wound infection. During the study period, a marked decline occurred in bacterial wound infection but not in fungal wound infection. Patients with either bacterial or fungal burn wound infection had massive injury, with burn size averaging greater than 50% of the total body surface area. Factors that appear to have markedly reduced bacterial burn wound infection, including patient isolation, topical chemotherapeutic agents, and burn wound excision, do not appear to have had a similar effect on fungal wound infection. The mechanism of spread and colonization of fungi, and the lack of effective topical chemotherapeutic antifungal agents, may explain in part our findings. (Arch Surg. 1991;126:44-48) References 1. Moncrief JA, Lindberg RB, Switzer WE, Pruitt BA Jr. Use of topical antibacterial therapy in the treatment of the burn wound . Arch Surg . 1966;92:558-565.Crossref 2. Nash G, Foley FD, Goodwin MN Jr, Bruck HM, Greenwald KA, Pruitt BA Jr. Fungal burn wound infection . JAMA . 1971;215:1664-1666.Crossref 3. Cervia JS, Murray HW. Fungal cholecystitis and AIDS . J Infect Dis . 1990;161:358.Crossref 4. Merrell SW, Shelby J, Freeman TR, Saffle JR. Effect of exchange transfusion on cell-mediated immune function following thermal injury . J Trauma . 1988;28:184-189.Crossref 5. Taber WA. Classification of fungi . In: Braude AI, ed. Medical Microbiology and Infectious Diseases . Philadelphia, Pa: WB Saunders Co; 1981:147-156. 6. Kim SH, Hubbard GB, Worley GB, McManus WF, Mason AD Jr, Pruitt BA Jr. A rapid section technique for burn wound biopsy . J Burn Care Rehabil . 1985;6:433-435.Crossref 7. Kim SH, Hubbard GB, McManus WF, Mason AD Jr, Pruitt BA Jr. Frozen section technique to evaluate early burn wound biopsy: a comparison with the rapid section technique . J Trauma . 1985;25:1134-1337.Crossref 8. McManus WF, Goodwin CW Jr, Pruitt BA Jr. Subeschar treatment of burn-wound infection . Arch Surg . 1983;118:291-294.Crossref 9. Spebar MJ, Walters MJ, Pruitt BA Jr. Improved survival with aggressive surgical management of noncandidal fungal infections of the burn wound . J Trauma . 1982;22:867-868.Crossref 10. Aldrich RH. The role of infection in burns: the theory and treatment with special reference to gentian violet . N Engl J Med . 1933;208:299-309.Crossref 11. Pruitt BA Jr. Phycomycotic infections . Prob Gen Surg . 1984;1:664-678. 12. Foley FD, Shuck JM. Burn-wound infection with phycomycetes requiring amputation of the hand . JAMA . 1968;203:596.Crossref 13. Stone HH, Cuzzell JZ, Kolb LD, Moskowitz MS, McGowan JE. Aspergillus infection of the burn wound . J Trauma . 1979;19:765-767.Crossref 14. McManus AT. Pseudomonas aeruginosa: a controlled burn pathogen? Antibiot Chemother . 1989;42:103-108. 15. Gartenberg G, Bottone EJ, Keusch GT, Weitzman I. Hospital acquired mucormycosis (Rhizopus rhizopodiformis) of skin and subcutaneous tissue: epidemiology, mycology, and treatment . N Engl J Med . 1978;224:1115-1118.Crossref 16. Kidson A, Lowbury EJL. Candida infections of burns . Burns . 1980;6:228-230.Crossref 17. Meyer RD, Young LS, Armstrong D, Yu B. Aspergillosis complicating neoplastic disease . Am J Med . 1973;54:6-15.Crossref 18. Grogan JB. Altered neutrophil phagocytic function in burn patients . J Trauma . 1976;16:734-738.Crossref 19. Burleson DG, Vaughn GK, Mason AD Jr, Pruitt BA Jr. Flow cytometric measurement of rat lymphocyte subpopulations after burn injury and burn injury with infection . Arch Surg . 1987;122:216-220.Crossref 20. Shirani KZ, Vaughan GM, McManus AT, et al. Replacement therapy with modified immunoglobulin G in burn patients: preliminary kinetic studies . Am J Med . 1984;76( (suppl 3A) ):175-180.Crossref 21. Bennett JE. Antifungal agents . In: Mandell GL, Douglas RG Jr, Bennett JE, eds. Principles and Practice of Infectious Diseases . 2nd ed. New York, NY: John Wiley & Sons Inc; 1979:343-353. 22. Desai MH, Herndon DH. Eradication of Candida burn wound septicemia in massively burned patients . J Trauma . 1988;28:140-145.Crossref 23. Chia JKS, Pollack M. Amphotericin B induces tumor necrosis factor production by murine macrophages . J Infect Dis . 1989;159:113-116.Crossref 24. Patterson TF, Miniter P, Dijkstra J, Szoka FC Jr, Ryan JL, Andriole VT. Treatment of experimental aspergillosis with novel amphotericin B/cholesterol-sulfate complexes . J Infect Dis . 1989;159:717-724.Crossref 25. Brajtburg J, Powderly WG, Kobayashi GS, Medoff G. Amphotericin B: current understanding of mechanisms of action . Antimicrob Agents Chemother . 1990;34:183-188.Crossref 26. Dismukes WE. Azole antifungal drugs: old and new . Ann Intern Med . 1988;109:177-179.Crossref 27. Kujath P, Lerch K. Secondary mycosis in surgery: treatment with fluconazole . Hosp Formal . 1990;25( (suppl B) ):23-29. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Surgery American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0004-0010
eISSN
1538-3644
DOI
10.1001/archsurg.1991.01410250048008
Publisher site
See Article on Publisher Site

Abstract

Abstract • To evaluate our experience with fungal burn wound infection, we performed a 10-year review for comparison with our experience with bacterial burn wound infection. During the study period, a marked decline occurred in bacterial wound infection but not in fungal wound infection. Patients with either bacterial or fungal burn wound infection had massive injury, with burn size averaging greater than 50% of the total body surface area. Factors that appear to have markedly reduced bacterial burn wound infection, including patient isolation, topical chemotherapeutic agents, and burn wound excision, do not appear to have had a similar effect on fungal wound infection. The mechanism of spread and colonization of fungi, and the lack of effective topical chemotherapeutic antifungal agents, may explain in part our findings. (Arch Surg. 1991;126:44-48) References 1. Moncrief JA, Lindberg RB, Switzer WE, Pruitt BA Jr. Use of topical antibacterial therapy in the treatment of the burn wound . Arch Surg . 1966;92:558-565.Crossref 2. Nash G, Foley FD, Goodwin MN Jr, Bruck HM, Greenwald KA, Pruitt BA Jr. Fungal burn wound infection . JAMA . 1971;215:1664-1666.Crossref 3. Cervia JS, Murray HW. Fungal cholecystitis and AIDS . J Infect Dis . 1990;161:358.Crossref 4. Merrell SW, Shelby J, Freeman TR, Saffle JR. Effect of exchange transfusion on cell-mediated immune function following thermal injury . J Trauma . 1988;28:184-189.Crossref 5. Taber WA. Classification of fungi . In: Braude AI, ed. Medical Microbiology and Infectious Diseases . Philadelphia, Pa: WB Saunders Co; 1981:147-156. 6. Kim SH, Hubbard GB, Worley GB, McManus WF, Mason AD Jr, Pruitt BA Jr. A rapid section technique for burn wound biopsy . J Burn Care Rehabil . 1985;6:433-435.Crossref 7. Kim SH, Hubbard GB, McManus WF, Mason AD Jr, Pruitt BA Jr. Frozen section technique to evaluate early burn wound biopsy: a comparison with the rapid section technique . J Trauma . 1985;25:1134-1337.Crossref 8. McManus WF, Goodwin CW Jr, Pruitt BA Jr. Subeschar treatment of burn-wound infection . Arch Surg . 1983;118:291-294.Crossref 9. Spebar MJ, Walters MJ, Pruitt BA Jr. Improved survival with aggressive surgical management of noncandidal fungal infections of the burn wound . J Trauma . 1982;22:867-868.Crossref 10. Aldrich RH. The role of infection in burns: the theory and treatment with special reference to gentian violet . N Engl J Med . 1933;208:299-309.Crossref 11. Pruitt BA Jr. Phycomycotic infections . Prob Gen Surg . 1984;1:664-678. 12. Foley FD, Shuck JM. Burn-wound infection with phycomycetes requiring amputation of the hand . JAMA . 1968;203:596.Crossref 13. Stone HH, Cuzzell JZ, Kolb LD, Moskowitz MS, McGowan JE. Aspergillus infection of the burn wound . J Trauma . 1979;19:765-767.Crossref 14. McManus AT. Pseudomonas aeruginosa: a controlled burn pathogen? Antibiot Chemother . 1989;42:103-108. 15. Gartenberg G, Bottone EJ, Keusch GT, Weitzman I. Hospital acquired mucormycosis (Rhizopus rhizopodiformis) of skin and subcutaneous tissue: epidemiology, mycology, and treatment . N Engl J Med . 1978;224:1115-1118.Crossref 16. Kidson A, Lowbury EJL. Candida infections of burns . Burns . 1980;6:228-230.Crossref 17. Meyer RD, Young LS, Armstrong D, Yu B. Aspergillosis complicating neoplastic disease . Am J Med . 1973;54:6-15.Crossref 18. Grogan JB. Altered neutrophil phagocytic function in burn patients . J Trauma . 1976;16:734-738.Crossref 19. Burleson DG, Vaughn GK, Mason AD Jr, Pruitt BA Jr. Flow cytometric measurement of rat lymphocyte subpopulations after burn injury and burn injury with infection . Arch Surg . 1987;122:216-220.Crossref 20. Shirani KZ, Vaughan GM, McManus AT, et al. Replacement therapy with modified immunoglobulin G in burn patients: preliminary kinetic studies . Am J Med . 1984;76( (suppl 3A) ):175-180.Crossref 21. Bennett JE. Antifungal agents . In: Mandell GL, Douglas RG Jr, Bennett JE, eds. Principles and Practice of Infectious Diseases . 2nd ed. New York, NY: John Wiley & Sons Inc; 1979:343-353. 22. Desai MH, Herndon DH. Eradication of Candida burn wound septicemia in massively burned patients . J Trauma . 1988;28:140-145.Crossref 23. Chia JKS, Pollack M. Amphotericin B induces tumor necrosis factor production by murine macrophages . J Infect Dis . 1989;159:113-116.Crossref 24. Patterson TF, Miniter P, Dijkstra J, Szoka FC Jr, Ryan JL, Andriole VT. Treatment of experimental aspergillosis with novel amphotericin B/cholesterol-sulfate complexes . J Infect Dis . 1989;159:717-724.Crossref 25. Brajtburg J, Powderly WG, Kobayashi GS, Medoff G. Amphotericin B: current understanding of mechanisms of action . Antimicrob Agents Chemother . 1990;34:183-188.Crossref 26. Dismukes WE. Azole antifungal drugs: old and new . Ann Intern Med . 1988;109:177-179.Crossref 27. Kujath P, Lerch K. Secondary mycosis in surgery: treatment with fluconazole . Hosp Formal . 1990;25( (suppl B) ):23-29.

Journal

Archives of SurgeryAmerican Medical Association

Published: Jan 1, 1991

References