Retrospective Investigation Of Invasive Fungal Infections In Severely Burned Adult Patients At Our Department In The Last Three Years

Objective:To provide reference for clinical prevention and treatment of invasive fungal infection(IFI), through epidemiological investigation and analysis of the predisposing factors of the patients who have suffered IFI after severe burned in the First Affiliated Hospital Burn Ward of Guangxi Medical University.Methods:188 cases were collected by retrospective survey method from adult patients with severe burn in the Burn and Plastic department of First Affiliated Hospital of Guangxi Medical University during March 2013 to February 2016. And statistics were analyzed in gender, age, cause of injury, burn area and degree, injury time, sampling time, fungal species, type specimens, inhalation injury, invasive medical procedures, and systemic hormones, broad-spectrum antibiotic use of these patients.1222 samples including blood, sputum (including sputum smear examination, throat swab), ducts, urine, feces, wound secretion and tissue biopsy specimens were collected to do fungal culture and microscopic examination from severe burn patients with suspected fungal infection in patients of 104 cases. If two specimens of the same type from one patient had the same fungi, the two specimens were counted to one positive sample. According to the guidelines of diagnosis and treatment of invasive fungal infection in burn patients (2012 Edition), IFI patients were diagnosed by retrospective analysis, and 188 patients were divided into infected group (group A) and non infected group (group B).Result:1、There were 188 cases of adult patients with severe burn, and 19 cases were diagnosed as IFI, the incidence rate of total positive cases was 10.1%.2、There is significant differences in the total area of burn wound, application of broad-spectrum antimicrobial, initial shaving(cuting) time, invasive operation. At the same time, age, inhalation injury and systemic hormonal application are also the important risk factors.3、91 samples were positive in fungal culture and microscopy in the 1222 specimens, the positive rate was 7.4%; 55 positive specimens were IFI.4、Fungus strains:7 types of fungi were detected in 55 strains.Candida albicans counted for 16 strains (29.1%),14 strains of Candida tropicalis (25.5%), 8 strains of Candida glabrata(14.5%),8 strains of Aspergillus(14.5%),7 strains of Mucor(12.7%),1 strain of Cryptococcus neoformans(1.8%), and 1 strain of corneal beads bacterium (1.8%).5、Specimens type:7 types were detected in the 55 specimens, burn wound exudates accounted for the first,26 (47.3%), followed by sputum 11 (20.0%), blood 8 (14.5%), urine 6 (10.9%), feces 2 (3.6%), catheter a (1.8%), a biopsy (1.8%).6、Cause of injury:11 cases(57.9%) of burn patients,6 cases(31.6%) of blast injury,1 cases(5.3%) of electrical burns,1 cases(5.3%) of chemical burns.7、In 55 positive samples, the detection rate was high in autumn and winter which accounted for 60% in two seasons.8、19 cases of IFI were diagnosed mainly in the time of 1 weeks to 3 weeks after injury, accounted for 63.2%.9、The mortality of group A (42.1%) was significantly higher than the group B(7.7%), and the difference was statistically significant (P< 0.05).Conclusion:In the last three years, the basic situation of invasive fungal infection in patients with severely burn is as follow:1、IFI is mainly caused by flame burn in one week to three weeks after the injury, it is mostly occurred in autumn and winter and Candida albicans was the main pathogenic fungi.2、Long-term use of several kinds of broad-spectrum antibacterial drugs, large and deep burn area, long time indwelling of ducts and inhalation injury is the most incentive factors of IFI, and old age, delay shaving (cutting) callus and systemic use of hormones is also possible predisposing factors.3、The early clinical manifestations of IFI is lack of specificity, physicians should observe the patient’s general dynamic condition, when one was highly suspected to IFI, blood, urine, sputum, placement of catheter, feces etc were examined to do fungal culture and identification of specimens except burn wound swabs. If necessary, chest or lung CT and pathological biopsy in a sterile environment can be taken to confirm the diagnosis.4、Although the incidence of IFI is low, the mortality rate is so high, so it’s worth to be paid attention to in clinical practice.