Multi‐state evaluation of Candida infections in burn patients

• Published in: Mycoses Vol. 67; no. 8; pp. e13788 - n/a
• Main Authors: Salimi, Maryam, Javidnia, Javad, Abastabar, Mahdi, Mobayen, Mohammad Reza, Moslemi, Azam, Rahimzadeh, Golnar, Yazdani Charati, Jamshid, Mirzaei Tirabadi, Nahid, Nouranibaladezaei, Seyedehzahra, Asghari, Hassan, Sobouti, Behnam, Dahmardehei, Mostafa, Seyedmousavi, Seyedmojtaba, Shokohi, Tahereh
• Format: Journal Article
• Language: English
• Published: Germany Wiley Subscription Services, Inc 01-08-2024
• Subjects: Adult; Aged; Antibiotics; Antifungal Agents - pharmacology; Antifungal Agents - therapeutic use; antifungal susceptibility; Burn patients; Burn Units; Burns - complications; Burns - microbiology; Candida; Candida - classification; Candida - drug effects; Candida - isolation & purification; Candida blood infection; Candida colonisation; Candidemia; Candidemia - drug therapy; Candidemia - epidemiology; Candidemia - microbiology; Candidemia - mortality; Candidiasis - epidemiology; Candidiasis - microbiology; Colonization; Demography; Diabetes mellitus; Drug Resistance, Fungal; Epidemiology; Female; Fluconazole; Fluconazole - pharmacology; Fluconazole - therapeutic use; Humans; Immunosuppression; Infections; Intensive Care Units; Iran - epidemiology; Male; Microbial Sensitivity Tests; Middle Aged; Mortality; Risk Factors; Species; Voriconazole; Young Adult; Iran; burn patients; Candida colonisation; Candida blood infection; antifungal susceptibility
• ISSN: 0933-7407; 1439-0507; 1439-0507
• DOI: 10.1111/myc.13788

Background
Burn patients are at high risk of developing secondary invasive fungal infections due to their compromised skin barrier, extensive use of antibiotics, and immunosuppression.
Objectives
We investigated demographic characteristics and clinical factors associated with Candida infections in intensive care unit (ICU) burn patients, and the in vitro antifungal susceptibility of species of isolates.
Methods
A total of 353 burn patients admitted to three major ICUs of burn centers in Iran were evaluated between 2021 and 2023. Patients were considered as colonisation and candidemia. Demographic characteristics, burn‐related factors, and clinical conditions were compared among the groups. Furthermore, we identified fungi at the species level and performed antifungal susceptibility testing according to CLSI guidelines.
Results
Overall, 46.2% of patients were colonised with a Candida species, leading to candidemia in 15.3%. The most frequently isolated species from candidemia and burn wound colonisation were Candida parapsilosis (37.0%) and Candida albicans (31.9%), respectively. Risk factors linked to candidemia included larger total body surface area (TBSA) (>50%), older patients, indwelling catheters, diabetes, and an extended ICU stay. Mortality rate was higher among candidemia patients (82.5%) compared to colonised patients (7.3%). The resistance rate of the strains isolated from candidemia to fluconazole and voriconazole was 28% and 18.2%, respectively.
Conclusion
We found that a higher percentage of TBSA burn injuries, longer hospital stays, and catheterization are important predictors of candidemia. The mortality rate was significantly higher in people infected with non‐albicans Candida species. Prevention and treatment strategies for candidemia should be based on updated, regional epidemiological data.