618. Invasive Fungal Infections Following Combat-Related Injury
Session: Abstracts: Mycology
Friday, October 22, 2010
Background:  

Combat wounds cause significant morbidity among soldiers.  Recent studies have highlighted the problem of multidrug-resistant bacteria associated with these injuries. Invasive mould infections are a rare complication of traumatic wounds.  No studies have examined the incidence and outcomes of invasive fungal infections in combat wounds.

Methods:  

A retrospective chart review from March 2002 through July 2008 of U.S. soldiers returning from Iraq and Afghanistan with traumatic wounds was performed.  A confirmed fungal wound infection was defined as growth of a known pathogenic mould and visualization of fungal elements on histopathology.  Patient records were reviewed for demographic variables and potential risk factors including site of infection, mechanism of injury, use of carbapenem-class antibiotics, treatment approaches and outcomes.

Results:  

Six cases were identified for an incidence of 0.4 cases/1,000 admissions for the 6 year period. The incidence of invasive mould infections increased over time (P=0.008) with a peak of 5.2 cases/1,000 admissions in 2007.  Isolated moulds included Aspergillus (n=4), Bipolaris (n=2) and 1 each Mucor and Absidia. Sites of infection included extremity (n=4) and 1 each thorax and abdomen.  All patients were male with a mean age of 22. Blast (n=5) and gunshot wound (n=1) were the sources of injury. All patients had fever (mean 102.9) and leukocytosis (mean WBC 25 x 103/µL). The average APACHE score was 22. All patients received a carbapenem-class antibiotic and three patients received total parenteral nutrition. Five patients (83%) had concomitant bacterial wound infections and central venous catheters. All patients received anti-fungal agents, surgical debridement and 3 required amputation revision. Average length of stay was 97 days and there were no deaths.

Conclusion:

Invasive mould infections are a rare complication of combat wounds but are associated with significant morbidity. These infections may be increasing in frequency and providers should be aware of potential risk factors.


Subject Category: M. Mycology including clinical and basic studies of fungal infections

Speakers:
Kristopher Paolino, MD , Walter Reed Army Medical Center, Gaithersburg, MD
James A. Henry, MD , Walter Reed Army Medical Center, Silver Spring, MD
Duane R. Hospenthal, MD , Brooke Army Medical Center, Fort Sam Houston, TX
Glenn Wortmann, MD , Walter Reed Army Medical Center, Olney, MD
Joshua Hartzell, MD , Walter Reed Army Medical Center, Washington, DC

Disclosures:

K. Paolino, None

J. A. Henry, None

D. R. Hospenthal, None

G. Wortmann, None

J. Hartzell, None

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