Invasive mold infections following combat-related injuries

Tyler Warkentien, Carlos Rodriguez, Bradley Lloyd, Justin Wells, Amy Weintrob, James R. Dunne, Anuradha Ganesan, Ping Li, William Bradley, Lakisha J. Gaskins, Françoise Seillier-Moiseiwitsch, Clinton K. Murray, Eugene V. Millar, Bryan Keenan, Kristopher Paolino, Mark Fleming, Duane R. Hospenthal, Glenn W. Wortmann, Michael L. Landrum, Mark G Kortepeter & 1 others David R. Tribble

Research output: Contribution to journalArticle

89 Citations (Scopus)

Abstract

Background.Major advances in combat casualty care have led to increased survival of patients with complex extremity trauma. Invasive fungal wound infections (IFIs) are an uncommon, but increasingly recognized, complication following trauma that require greater understanding of risk factors and clinical findings to reduce morbidity.Methods. The patient population includes US military personnel injured during combat from June 2009 through December 2010. Case definition required wound necrosis on successive debridements with IFI evidence by histopathology and/or microbiology (Candida spp excluded). Case finding and data collected through the Trauma Infectious Disease Outcomes Study utilized trauma registry, hospital records or operative reports, and pathologist review of histopathology specimens.Results.A total of 37 cases were identified: proven (angioinvasion, n = 20), probable (nonvascular tissue invasion, n = 4), and possible (positive fungal culture without histopathological evidence, n = 13). In the last quarter surveyed, rates reached 3.5 of trauma admissions. Common findings include blast injury (100) during foot patrol (92) occurring in southern Afghanistan (94) with lower extremity amputation (80) and large volume blood transfusion (97.2). Mold isolates were recovered in 83 of cases (order Mucorales, n = 16; Aspergillus spp, n = 16; Fusarium spp, n = 9), commonly with multiple mold species among infected wounds (28). Clinical outcomes included 3 related deaths (8.1), frequent debridements (median, 11 cases), and amputation revisions (58).Conclusions.IFIs are an emerging trauma-related infection leading to significant morbidity. Early identification, using common characteristics of patient injury profile and tissue-based diagnosis, should be accompanied by aggressive surgical and antifungal therapy (liposomal amphotericin B and a broad-spectrum triazole pending mycology results) among patients with suspicious wounds.

Original languageEnglish (US)
Pages (from-to)1441-1449
Number of pages9
JournalClinical Infectious Diseases
Volume55
Issue number11
DOIs
StatePublished - Dec 1 2012

Fingerprint

Fungi
Wounds and Injuries
Infection
Debridement
Amputation
Mucorales
Blast Injuries
Mycology
Morbidity
Afghanistan
Triazoles
Hospital Records
Military Personnel
Fusarium
Wound Infection
Aspergillus
Microbiology
Candida
Blood Transfusion
Communicable Diseases

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Warkentien, T., Rodriguez, C., Lloyd, B., Wells, J., Weintrob, A., Dunne, J. R., ... Tribble, D. R. (2012). Invasive mold infections following combat-related injuries. Clinical Infectious Diseases, 55(11), 1441-1449. https://doi.org/10.1093/cid/cis749

Invasive mold infections following combat-related injuries. / Warkentien, Tyler; Rodriguez, Carlos; Lloyd, Bradley; Wells, Justin; Weintrob, Amy; Dunne, James R.; Ganesan, Anuradha; Li, Ping; Bradley, William; Gaskins, Lakisha J.; Seillier-Moiseiwitsch, Françoise; Murray, Clinton K.; Millar, Eugene V.; Keenan, Bryan; Paolino, Kristopher; Fleming, Mark; Hospenthal, Duane R.; Wortmann, Glenn W.; Landrum, Michael L.; Kortepeter, Mark G; Tribble, David R.

In: Clinical Infectious Diseases, Vol. 55, No. 11, 01.12.2012, p. 1441-1449.

Research output: Contribution to journalArticle

Warkentien, T, Rodriguez, C, Lloyd, B, Wells, J, Weintrob, A, Dunne, JR, Ganesan, A, Li, P, Bradley, W, Gaskins, LJ, Seillier-Moiseiwitsch, F, Murray, CK, Millar, EV, Keenan, B, Paolino, K, Fleming, M, Hospenthal, DR, Wortmann, GW, Landrum, ML, Kortepeter, MG & Tribble, DR 2012, 'Invasive mold infections following combat-related injuries', Clinical Infectious Diseases, vol. 55, no. 11, pp. 1441-1449. https://doi.org/10.1093/cid/cis749
Warkentien T, Rodriguez C, Lloyd B, Wells J, Weintrob A, Dunne JR et al. Invasive mold infections following combat-related injuries. Clinical Infectious Diseases. 2012 Dec 1;55(11):1441-1449. https://doi.org/10.1093/cid/cis749
Warkentien, Tyler ; Rodriguez, Carlos ; Lloyd, Bradley ; Wells, Justin ; Weintrob, Amy ; Dunne, James R. ; Ganesan, Anuradha ; Li, Ping ; Bradley, William ; Gaskins, Lakisha J. ; Seillier-Moiseiwitsch, Françoise ; Murray, Clinton K. ; Millar, Eugene V. ; Keenan, Bryan ; Paolino, Kristopher ; Fleming, Mark ; Hospenthal, Duane R. ; Wortmann, Glenn W. ; Landrum, Michael L. ; Kortepeter, Mark G ; Tribble, David R. / Invasive mold infections following combat-related injuries. In: Clinical Infectious Diseases. 2012 ; Vol. 55, No. 11. pp. 1441-1449.
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abstract = "Background.Major advances in combat casualty care have led to increased survival of patients with complex extremity trauma. Invasive fungal wound infections (IFIs) are an uncommon, but increasingly recognized, complication following trauma that require greater understanding of risk factors and clinical findings to reduce morbidity.Methods. The patient population includes US military personnel injured during combat from June 2009 through December 2010. Case definition required wound necrosis on successive debridements with IFI evidence by histopathology and/or microbiology (Candida spp excluded). Case finding and data collected through the Trauma Infectious Disease Outcomes Study utilized trauma registry, hospital records or operative reports, and pathologist review of histopathology specimens.Results.A total of 37 cases were identified: proven (angioinvasion, n = 20), probable (nonvascular tissue invasion, n = 4), and possible (positive fungal culture without histopathological evidence, n = 13). In the last quarter surveyed, rates reached 3.5 of trauma admissions. Common findings include blast injury (100) during foot patrol (92) occurring in southern Afghanistan (94) with lower extremity amputation (80) and large volume blood transfusion (97.2). Mold isolates were recovered in 83 of cases (order Mucorales, n = 16; Aspergillus spp, n = 16; Fusarium spp, n = 9), commonly with multiple mold species among infected wounds (28). Clinical outcomes included 3 related deaths (8.1), frequent debridements (median, 11 cases), and amputation revisions (58).Conclusions.IFIs are an emerging trauma-related infection leading to significant morbidity. Early identification, using common characteristics of patient injury profile and tissue-based diagnosis, should be accompanied by aggressive surgical and antifungal therapy (liposomal amphotericin B and a broad-spectrum triazole pending mycology results) among patients with suspicious wounds.",
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AU - Rodriguez, Carlos

AU - Lloyd, Bradley

AU - Wells, Justin

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AU - Dunne, James R.

AU - Ganesan, Anuradha

AU - Li, Ping

AU - Bradley, William

AU - Gaskins, Lakisha J.

AU - Seillier-Moiseiwitsch, Françoise

AU - Murray, Clinton K.

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AU - Keenan, Bryan

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N2 - Background.Major advances in combat casualty care have led to increased survival of patients with complex extremity trauma. Invasive fungal wound infections (IFIs) are an uncommon, but increasingly recognized, complication following trauma that require greater understanding of risk factors and clinical findings to reduce morbidity.Methods. The patient population includes US military personnel injured during combat from June 2009 through December 2010. Case definition required wound necrosis on successive debridements with IFI evidence by histopathology and/or microbiology (Candida spp excluded). Case finding and data collected through the Trauma Infectious Disease Outcomes Study utilized trauma registry, hospital records or operative reports, and pathologist review of histopathology specimens.Results.A total of 37 cases were identified: proven (angioinvasion, n = 20), probable (nonvascular tissue invasion, n = 4), and possible (positive fungal culture without histopathological evidence, n = 13). In the last quarter surveyed, rates reached 3.5 of trauma admissions. Common findings include blast injury (100) during foot patrol (92) occurring in southern Afghanistan (94) with lower extremity amputation (80) and large volume blood transfusion (97.2). Mold isolates were recovered in 83 of cases (order Mucorales, n = 16; Aspergillus spp, n = 16; Fusarium spp, n = 9), commonly with multiple mold species among infected wounds (28). Clinical outcomes included 3 related deaths (8.1), frequent debridements (median, 11 cases), and amputation revisions (58).Conclusions.IFIs are an emerging trauma-related infection leading to significant morbidity. Early identification, using common characteristics of patient injury profile and tissue-based diagnosis, should be accompanied by aggressive surgical and antifungal therapy (liposomal amphotericin B and a broad-spectrum triazole pending mycology results) among patients with suspicious wounds.

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