Outcome and characteristics of invasive fungal infections in critically ill burn patients: A multicenter retrospective study.

Abstract

Characteristics and outcome of invasive fungal infection (IFI) in critically ill burn patients have been poorly explored. We report the factors associated with 90-day mortality in a multicentre retrospective European study. All burn patients with confirmed IFI admitted between 1 January 2010 to 31 December 2015 in 10 centres in France and Belgium were included. Ninety-four patients were enrolled with 110 cases of IFIs: 79 (71.8%) were yeasts IFI and 31 (28.2%) filamentous IFI. Incidence was 1% among admitted patients. The 90-day mortality was 37.2% for all IFIs combined, 52% for filamentous infection and 31.9% for yeast infection. Patients with more than one IFI had a higher 90-day mortality than patients with only one episode (61.5% vs 33.5% (P=.006)). In multivariate analysis, higher Simplified Acute Physiology Score II (OR=1.05 (95% CI: 1.02-1.09) P=.003), bacterial co-infection (OR=3.85 (95% CI: 1.23-12.01), P=.014) and use of skin allografts at the time of IFI diagnosis (OR=3.87 (95% CI: 1.31-11.42), P=.021) were associated with 90-day mortality. Although rare, invasive fungal infections remain associated with poor outcome in burn patients. Bacterial co-infection and presence of allograft were potentially modifiable factors independently associated with outcome.