Etiological characteristics and risk factors of fungal infection in severe burn patients
Objective To analyze the etiological characteristics of fungal infections in patients with severe burns and to investigate the risk factors for fungal infections in these patients.Methods Selected 598 patients with severe burns who met the inclusion criteria from the Burn Intensive Care Unit(BICU)of the Red Cross Hospital in Guangzhou from January 2013 to December 2022 as research subjects.It also compiled the results of fungal cultures and drug sensitivity from wound secretions,sputum,blood,midstream urine,feces,and catheter tip specimens.Patients with invasive fungal infections(IFI)were diagnosed according to the"Guidelines for the Diagnosis and Prevention of Invasive Fungal Infections in Burns(2012 Edition)",and the clinical characteristics of infected patients were compared with those of non-infected patients.Results Over the 10-year period,41 patients were diagnosed with post-burn IFI,with a fungal infection rate of 6.86%,and 5 deaths,resulting in a mortality rate of 12.16%.A total of 124 fungal strains were isolated from 41 patients with post-burn IFI over the same period,with the top three comprising Candida tropicalis(28 strains,22.58%),Candida parapsilosis(28 strains,22.58%),and Candida albicans(24 strains,19.35%).Compared to the first 5 years,the proportion of Candida albicans decreased in the latter 5 years,while the proportion of non-albicans Candida and rare fungi increased.Over the 10 years,the top three sources of positive samples for IFI patients were wound secretions(128 samples,53.56%),blood(47 samples,19.67%),and sputum(28 samples,11.72%).The independent risk factors for fungal infections in burn patients were the area of Ⅲdegree burns(OR=1.03,95%CI:1.01-1.05,P<0.05),mechanical ventilation≥14 days(OR=3.34,95%CI:1.10-12.62,P<0.05),use of≥3 types of broad-spectrum antibiotics(OR=4.97,95%CI:2.36-11.12,P<0.05),and acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ)score(OR=1.18,95%CI:1.10-1.30,P<0.05).Conclusions Fungal infections in patients with severe burns were on the rise,and the detection rate of non-albicans Candida and rare fungi had increased.The area of Ⅲ degree burns,mechanical ventilation≥14 days,use of≥3 types of broad-spectrum antibiotics,and the APACHE Ⅱ score were independent risk factors for fungal infections in burn patients.
Severe burnsInvasiveFungal infectionsMechanical ventilation
NETL
NSTL
万方数据
