Incidence of Candidemia and Related Mortality Following Severe Burns

ABSTRACT

PURPOSE: Severe burn patients are easily exposed to infection due to immune compromise and loss of skin barrier. But in spite of advances in burn treatment, complication due to infection has significant influence in mortality and morbidity. Broad spectrum antibiotics are used empirically to reduce bacterial infection in severe burn patients but results in suppression of normal flora and mucosal damage in intestine which facilitates fungal growth. We investigated the incidence, frequent onset time, characteristics of patients with candidemia and found appropriate time for use of antifungal agents and treatment of infection. METHODS: We reviewed the medical records of patients who were admitted to Hangang sacred heart hospital burn ICU between January 2007 and December 2008. RESULTS: In 2007 395 patients were admitted to BICU and 66 patients (16.7%) had fungal infection. In 2008 331 patients were admitted to BICU and 77 patients (23.3%) had fungal infection. Fungus was isolated in blood culture in 22 patients (5.6%) and 7 patients (2.1%) in 2007 and 2008 respectively. 20 patients out of 28 patients with candidemia received ventilator care (p=0.037), mean stay in ICU was 52.2 days in patients with positive blood culture compared with 36.5 days in patients with negative blood culture (p=0.049). Mortality in candidemia patients was 42.9% (p=0.022) which was high. CONCLUSION: Candidemia frequently occurs in patients receiving ventilator care, and as stay in ICU lengthens financial burden increases and results in higher mortality and morbidity. Lowering morbidity through strict infection control and monitoring is needed.