Volume 25, Number 9—September 2019
CME ACTIVITY - Synopsis
Classification of Trauma-Associated Invasive Fungal Infections to Support Wound Treatment Decisions
, 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
Table 3
Characteristics of US military patients with laboratory evidence of invasive fungal infection of wound sustained on battlefield, Afghanistan, June 1, 2009–December 31, 2014*
| Characteristic | IFI, n = 94 | High suspicion, n = 61 | p value† | Low suspicion, n = 91 | p value‡ |
|---|---|---|---|---|---|
| Blast injury | 92 (97.9) | 61 (100) | 0.520 | 89 (97.8) | 1.000 |
| Injured while on foot patrol§ |
73 (94.8) |
51 (94.4) |
1.000 |
80 (95.2) |
1.000 |
| Injury severity score | |||||
| Median (IQR) | 40 (33–50) | 38 (30–45) | 0.262 | 33 (27–42) | <0.001 |
| ≥26/critical |
87 (92.6) |
52 (85.3) |
0.144 |
75 (82.4) |
0.037 |
| Blood units received 24 h after injury, median (IQR)¶ | 31 (21–43) | 21 (15–32) | 0.003 | 17 (12–24) | <0.001 |
| 10–20 | 18 (19.4) | 25 (41.0) | 0.003 | 42 (48.3) | <0.001 |
| >20 |
71 (76.3) |
31 (50.8) |
0.002 |
30 (34.5) |
<0.001 |
| Traumatic amputation# |
64 (68.1) |
48 (78.7) |
0.150 |
73 (80.2) |
0.060 |
| SOFA score, median (IQR) | |||||
| Germany | 11 (7–13) | 8 (4–13) | 0.028 | 6 (2–9) | <0.001 |
| US hospital |
7 (2–11) |
4 (1–8) |
0.022 |
1 (0–6) |
<0.001 |
| Duration of antifungal use, median (IQR) |
24 (14–43) |
21 (14–27) |
0.006 |
0 |
NA |
| Outcome | |||||
| Surgical amputation** | 50 (53.2) | 26 (42.6) | 0.199 | 24 (26.4) | <0.001 |
| Death | 8 (8.5) | 1 (1.6) | 0.090 | 0 | 0.007 |
*Values are no. (%) except as indicated. Patients with >1 wound with differing classifications are classified at the highest level. One patient with a wound classified as high suspicion died within 24 h of collection of sample providing laboratory evidence of fungal infection, precluding classification as having an IFI. IFI, invasive fungal wound infection; IQR, interquartile range; SOFA, sequential organ failure assessment.
†Compares characteristics between those having an IFI and those having a high-suspicion wound.
‡Compares characteristics between those having an IFI and those having a low-suspicion wound.
§Information about whether patient was on foot patrol or in a vehicle is missing for 17 IFI patients, 7 patients with high-suspicion wounds, and 7 patients with low-suspicion wounds. Percentages and p-values based on total minus missing.
¶Information missing for 1 patient with an IFI and 4 patients with low-suspicion wounds. Percentages and p-values based on total minus missing.
#Includes amputations that occurred before admission to a US hospital.
**Defined as amputation that occurred after admission to a US hospital.