748 - Epidemiology and Outcomes of Invasive Fungal Infections Following Civilian Trauma

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Presenting Author(s)

PM

Patrick B. Mazi

Infectious Disease Fellow
Washington University
St Louis, Missouri
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.

Co-Author(s)

GB

Grant Bochicchio

Chief, Acute and Critical Care Surgery
Washington Universtiy
St Louis, Missouri
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
KB

Kelly M. Bochicchio

Clinical Research Manager, Senior Research Administrator
Washington University in St. Louis School of Medicine
St. Louis, Missouri
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
SL

Stephen Liang

Assistant Professor of Medicine
Washington University School of Medicine
St. Louis, Missouri
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
LL

Lindsey Larson

Research Coordinator
Washington University School of Medicine
St Louis, MO
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JA

JOSE A. ALDANA

POSTDOC RESEARCH ASSOCIATE
ACCS
SAINT LOUIS, Missouri
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
MC

Melissa Canas

Post Doctoral Research Associate
Washington University in St Louis
St Louis, Missouri
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
RF

Ricardo A. Fonseca

Post Doctoral Research Associate
Washington University in St. Louis
St. Louis, Missouri
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
HA

Hussain Afzal

Post Doctoral Associate
Washington university school of medicine
Saint Louis, Missouri
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
RR

Rohit K. Rasane

MBBS, MS (General Surgery)
Washington University in Saint Louis
Saint Louis, Missouri
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JR

Javier E. Rincon

MD
Washington University in St. Louis
St. Louis, Missouri
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
JM

James M. McMullen

Research Assistant
Washington University in St. Louis
Brookfield, Wisconsin
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
CZ

Christina X. Zhang

Postdoc Research Associate
Washington University in. St. Louis
Brooklyn, New York
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
WP

William G. Powderly

Chief
Washington University School of Medicine
St. Louis, Missouri
Disclosure: I do not have any relevant financial / non-financial relationships with any proprietary interests.
AS

Andrej Spec

Asst. Professor of Medicine
Washington University, St. Louis
St. Louis, Missouri
Disclosure: SCYNEXIS, Inc. (Scientific Research Study Investigator, Advisor or Review Panel member)

Background: Invasive fungal infections (IFI) following traumatic injury are devastating complications that threaten life and limb. In military combat wounds, post-traumatic IFI patients have up to 6 times higher mortality rates and 2.6-5.1 times higher rate of high-level amputations compared to non-IFI patients, though no such data exists for the civilian population. This study is the first cohort to analyze a post-traumatic civilian population for IFI, its epidemiology and outcomes.

Methods: We conducted a single-center retrospective cohort study of all trauma patients over the age of 18 years admitted to a large tertiary referral hospital between 2004 to 2015 who required surgery for their injury and had operative cultures submitted from their wounds. Patient demographics, comorbid conditions, mechanisms of trauma, environmental exposures, and laboratory data were included for analysis. Patients with positive culture for fungus from a site compatible with IFI were considered IFI patients. Data was analyzed using descriptive statistics with p≤0.05 considered significant.

Results: Our cohort includes 1,107 patients that met inclusion criteria. Of these, 120 patients had a positive culture for fungus, 454 patients had a positive culture for bacteria and 533 patients had no positive culture from a site of interest. Basic patient demographics, geographical setting of the trauma, and anatomical site of injury were not significantly associated with having a positive fungal culture. Necrosis was present in 19 (15.8%) IFI vs. 74 (7.5%) non-IFI patients (p=0.002). Soil contamination of a wound was present in 6 (5.0%) IFI vs. 11 (1.1%) non-IFI patients (p=0.001). 55.8% of 120 IFI wounds penetrated below fascial layers compared to 26.7% of 987 non-IFI wounds (p< 0.001).
Presence of IFI increased likelihood of requiring amputation (6.7% vs. 2.7%, p=0.02) and prolonged hospitalization >14 days (77.5% vs. 57.4%, p< 0.001) compared to those without.

Conclusion: IFI significantly increased patient risk for amputation and prolonged hospital length of stay following traumatic injury in a civilian population. Presence of IFI was associated with wounds penetrating below the fascial layer, presence of wound necrosis, and soil contamination of a wound.