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CANDIDA AND THERMAL INJURY: 10 years EXPERIENCE FROM A SPECIALIST BURNS UNIT
Author(s) -
Moore E. C.,
Padiglione A.,
Wasiak J.,
Paul E.,
Cleland H.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04927_18.x
Subject(s) - medicine , candida albicans , colonisation , sepsis , risk factor , incidence (geometry) , intensive care medicine , surgery , colonization , microbiology and biotechnology , biology , physics , optics
Sepsis due to Candida is a rare but significant cause of death in burns patients. Indications for prophylaxis against invasive Candida infection are unclear in patients with thermal injury. Consensus statements do not specifically include this cohort. We conducted a ten year review of burns patients to the Victorian Adult Burns Service, to identify the extent and clinical significance of Candida infection in a specialist burns unit. Our aim was to define predictive factors for Candidaemia, in order to guide protocols for prevention and early treatment. Between July 1, 1998 and December 31, 2007, 1933 patients were newly admitted with acute burns; of these 143 patients had Candida or Yeast isolated at any site. The most common species was C.albicans. Twelve patients developed 13 episodes of Candidaemia. Prior colonisation was an important risk factor for Candidaemia, and the risk increased substantially with increased number of colonised sites. Other risk factors for Candidaemia were: higher percent TBSA (total burn surface area); increased number of visits to the operating theatre; colonisation of particular sites and prior treatment with TPN and certain antibiotics. The attributable mortality of Candidaemia was 15% (n = 2). Initiation of appropriate antifungal therapy was often delayed. Our results justify early empirical anti‐fungal therapy in septic burns patients who are colonized, before the results of cultures become known. The role of prophylactic antifungals is less clear, but should be strongly considered for high risk patients colonized at multiple sites.