1453. Non-Candida Fungal Wound Cultures in a Regional Burn Intensive Care Unit, 2008-2012
Session: Poster Abstract Session: Fungal Infections
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C

Background:   Fungal infection is a rare but life threatening finding in burn patients. While most current literature focuses on incidence, risk, and mortality of fungal burn wound infections, the topics of surveillance and prevention are largely ignored. The Johns Hopkins Burn Center is a ten-bed regional burn center that sees over 400 admissions annually. In our burn center patients undergo regular wound inspection and wound cultures are obtained based on clinical suspicion. Additionally, patients with burns greater than 40% total body surface area (TBSA) receive oral fluconazole for antifungal prophylaxis starting day three of hospital admission. In this study we describe the incidence and characterization of non-candida fungal (NCF) cultures in a regional burn center over a five year period.

Methods:   We retrospectively reviewed all patients admitted to a dedicated burn intensive care unit (BICU) from 2008 to 2012. Wounds were inspected daily, and cultures collected based on the clinical appearance and suspicion for wound infection. Microbiologic results and patient characteristics were obtained from our electronic medical record system.

Results:   From 2008 to 2012 there were 2,051 BICU admissions with 9,054 cultures obtained, yielding 123 candida positive and 25 positive NCF cultures.  Whereas ninety-three patients (93/2051; 4.5%)  had a candida positive culture, only nine burn patients and four patients with severe soft tissue disease grew mold (13/2051; .006%). Of those, the majority of NCF cultures occurred in burn patients (9/13; 69.2%) and in those with >40% TBSA involvement (7/9; 69%). Patients with a history of diabetes had positive fungal cultures earlier than those without (8.5 vs. 30.6 days, p<.01).  Mortality was high for patients (8/13; 61.5%) with positive NCF culture.

Conclusion:   While burn patients are at high risk for wound related mycoses, the incidence of patients with a positive NCF culture in our BICU is exceedingly low (.006%). The incidence of positive fungal culture was just 4.7%, which is lower than the 6-7% incidence reported in the other major burn centers. The use of oral antifungal agents as prophylaxis as well as implementation of effective infection control measures may reduce mycosis related mortality in the critically ill burn population.

Parker Fillmore, MD, MPH1, Geeta Sood, MD1, Leigh Ann Price, MD1, Jonathan M. Zenilman, MD, FIDSA1, Zeina Khouri-Stevens, PhD, RN2, Stefan Riedel, MD, PhD1 and Stephen Milner, MBBS, BDS, DSc (Hon), FRCS (Ed), FACS1, (1)Johns Hopkins University School of Medicine, Baltimore, MD, (2)Johns Hopkins Bayview Medical Center, Baltimore, MD


P. Fillmore, None

G. Sood, None

L. A. Price, None

J. M. Zenilman, None

Z. Khouri-Stevens, None

S. Riedel, None

S. Milner, None

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