Outcome and characteristics of invasive fungal infections in critically ill burn patients: A multicenter retrospective study
Outcome and characteristics of invasive fungal infections in critically ill burn patients: A multicenter retrospective study
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DOI：
10.1111/myc.13068
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发表时间：
2020-05-10
期刊：
影响因子：
4.9
通讯作者：
Legrand, Matthieu
中科院分区：
文献类型：
--
作者：
Maurel, Veronique;Denis, Blandine;Legrand, Matthieu
背景危重烧伤患者侵袭性真菌感染（IFI）的特征和结局尚不清楚。目的我们报告了一项多中心回顾性欧洲研究中与90天死亡率相关的因素。患者/方法纳入了2010年1月1日至2015年12月31日期间在法国和比利时的10个中心收治的所有确诊IFI的烧伤患者。结果90例患者中有10例为急性感染，其中10例为急性感染。入组4例患者，共110例IFI：79例（71.8%）为酵母IFI，31例（28.2%）为丝状IFI。住院患者中的发病率为1%。90天死亡率为37.2%，所有IFIs合并，52%的丝状菌感染和31.9%的酵母菌感染。发生一次以上IFI的患者的90天死亡率高于仅发生一次IFI的患者（61.5% vs 33.5%（P = 0.006））。在多变量分析中，较高的简化急性生理学评分II（OR = 1.05（95% CI：1.02-1.09）P = .003），细菌合并感染（OR = 3.85（95% CI：1.23-12.01），P = 0.014）和IFI诊断时使用皮肤移植物（OR = 3.87（95%CI：1.31-11.42），P = 0.021）与90天死亡率相关。结论虽然罕见，但侵袭性真菌感染仍与烧伤患者预后不良相关。细菌合并感染和同种异体移植物的存在是与结果独立相关的潜在可变因素。
Background Characteristics and outcome of invasive fungal infection (IFI) in critically ill burn patients have been poorly explored.Objectives We report the factors associated with 90-day mortality in a multicentre retrospective European study.Patients/Methods All burn patients with confirmed IFI admitted between 1 January 2010 to 31 December 2015 in 10 centres in France and Belgium were included.Results 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.Conclusions 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.