Ann Burns Fire Disasters. 2016 Jun 30;29(2):90-93.

Epidemiology of nosocomial fungal infections in the National Center for Burns in Casablanca, Morocco.

Annals of burns and fire disasters

A Rafik, M Diouri, N Bahechar, A Chlihi

PMID: 28149227 PMCID: PMC5286990

Abstract

Fungal infection is a leading cause of death in burns patients and incurs significant costs for burn units. Our aim was to determine epidemiology of these infections, and analyze risk factors in the burns intensive care unit of the National Center for Burns and Plastic Surgery at Ibn-Rochd University Hospital, Casablanca. It is a retrospective review of all patients admitted from 2011-2014 who developed cultures positive for fungal organisms. Criteria for nosocomial fungal infections were those of the Center for Disease Control in Atlanta (1988, revised 1992, 2004). Microbiological surveillance was carried out daily. Patient demographic data, % TBSA, type of infection, site(s), species and number of cultures, and risk factors for fungal infections were collected. Mean age of patients was 24.5 +/- 27.3 years; 63% were female. Mean % TBSA was 30.7 +/- 23.4%, and % FTSA was 21.7 +/- 20.1%. Injury due to flame was most common (82%), followed by scald (10%), contact (4%), electrical (3%) and chemical (1%). Incidence of nosocomial fungal infection was 10%. The fungal pathogen most frequently isolated was Candida albicans (65.7%), followed by other Candida species (18.6%). Aspergillus spp was present in 3.9% and was statistically associated with mortality (3.2%) and morbidity. In our study, risk factors for these infections were mostly degree of burn (mean TBSA = 30.7%) and prolonged broad-spectrum antibiotic therapy. These two factors were associated with a higher incidence of multiple positive cultures, and significantly increased mortality (21.6%). Amphotericin B and fluconazole were the most frequently used antifungal agents. Fungi are emerging as important nosocomial pathogens. The main clinical implications are thinking faster about fungi infections and being more careful with antibiotic prescriptions.

Keywords: burn intensive care; burns; fungal infection

References

1. Burns Incl Therm Inj. 1984 Oct;11(1):16-25 - PubMed
2. Pediatr Crit Care Med. 2013 Mar;14(3):e120-5 - PubMed
3. Surg Infect (Larchmt). 2002 Winter;3(4):367-74 - PubMed
4. J Burn Care Res. 2011 Jan-Feb;32(1):104-9 - PubMed
5. Arch Intern Med. 1988 Dec;148(12):2642-5 - PubMed
6. Surg Infect (Larchmt). 2003 Winter;4(4):345-54 - PubMed
7. Burns. 2015 Jun;41(4):853-63 - PubMed
8. Burns. 2007 May;33(3):341-6 - PubMed
9. Burns. 2016 Mar;42(2):258-66 - PubMed
10. Intensive Care Med. 1997 Mar;23(3):317-25 - PubMed
11. J Burn Care Res. 2008 Jan-Feb;29(1):213-21 - PubMed
12. Intensive Care Med. 2002 Dec;28(12):1708-17 - PubMed
13. Arch Intern Med. 1989 Oct;149(10):2349-53 - PubMed
14. Curr Opin Infect Dis. 2002 Dec;15(6):561-3 - PubMed
15. Arch Surg. 1992 Feb;127(2):159-62 - PubMed
16. Crit Care. 2015 Jan 12;19:7 - PubMed
17. Ann Burns Fire Disasters. 2013 Sep 30;26(3):147-53 - PubMed
18. Burns. 2008 Dec;34(8):1108-12 - PubMed
19. Am J Med. 1984 Mar 30;76(3A):146-54 - PubMed
20. Ann Surg. 2001 Apr;233(4):542-8 - PubMed
21. Burns. 2009 Jun;35(4):561-4 - PubMed
22. Presse Med. 2002 May 25;31(18):841-8 - PubMed
23. Burns. 2003 May;29(3):229-33 - PubMed
24. World J Surg. 1998 Feb;22(2):135-45 - PubMed
25. Korean J Urol. 2011 Sep;52(9):626-31 - PubMed

Publication Types

• Journal Article