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Volume 25, Number 9—September 2019
CME ACTIVITY - Synopsis

Classification of Trauma-Associated Invasive Fungal Infections to Support Wound Treatment Decisions

Anuradha GanesanComments to Author , Faraz Shaikh, William Bradley, Dana M. Blyth, Denise Bennett, Joseph L. Petfield, M. Leigh Carson, Justin M. Wells, David R. Tribble, and Infectious Disease Clinical Research Program Trauma Infectious Disease Outcomes Study Group
Author affiliations: The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA (A. Ganesan, F. Shaikh, W. Bradley, D. Bennett, M.L. Carson); Uniformed Services University of the Health Sciences, Bethesda (A. Ganesan, F. Shaikh, W. Bradley, D. Bennett, M.L. Carson, D.R. Tribble); Walter Reed National Military Medical Center, Bethesda (A. Ganesan, J.M. Wells); Brooke Army Medical Center, San Antonio, Texas, USA (W. Bradley, D.M. Blyth); Landstuhl Regional Medical Center, Landstuhl, Germany (J.L. Petfield)

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Table 2

Characteristics of US military patients with IFI after battlefield trauma in Afghanistan, June 1, 2009–December 31, 2014*

Characteristic IFI
 p value
Proven, n = 40 Probable, n = 30 Possible, n = 24
Blast injury 40 (100) 29 (96.7) 23 (95.8) 0.327
Injured while on foot patrol†
 29 (100)
 26 (96.3)
 18 (85.7)
 0.062
Injury severity score
Median (IQR) 42 (33–57) 40 (33–50) 35 (30–44) 0.127
>26/critical
 39 (97.5)
 27 (90.0)
 21 (87.5)
 0.279
Blood units received 24 h after injury‡
  Median (IQR) 31 (23–43) 34 (23–47) 27 (17–37) 0.276
10–20 units 6 (15.0) 4 (13.3) 8 (34.8) 0.121
>20 units
 33 (82.5)
 24 (80.0)
 14 (60.9)
 0.074
Traumatic amputation§
 30 (75.0)
 20 (66.7)
 14 (58.3)
 0.376
SOFA score, median (IQR)
  Germany 11 (8–15) 10.5 (7–12) 11 (5–12) 0.413
  US hospital
 9 (5–13)
 7.5 (1–11)
 4.5 (1–7.5)
 0.007
Duration of antifungal use, median (IQR)
 36 (23–49)
 24 (18–36)
 16 (0–24)
 <0.001
Outcome
  Surgical amputations¶ 27 (67.5) 13 (43.3) 10 (41.7) 0.057
  Death 7 (17.5) 1 (3.3) 0 0.030

*Values are no. (%) except as indicated. IFI, invasive fungal wound infections; IQR, interquartile range; SOFA, sequential organ failure assessment.
†Status of whether patient was on foot patrol or in a vehicle is missing for 17 IFI patients (11 Proven, 3 Probable, and 3 Possible). Percentages and p-values based on total minus missing.
‡Blood information is missing for 1 patient with a possible IFI. Percentages and p-values based on total minus missing.
§Includes amputations that occurred before admission to a US hospital.
¶Defined as amputations that occurred after admission to a US hospital.

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Page created: August 20, 2019
Page updated: August 20, 2019
Page reviewed: August 20, 2019
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
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