Multi-state evaluation of Candida infections in burn patients.

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.

A case series of concomitant burn and COVID-19.

BACKGROUND: The recently emerged severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) disease (COVID-19) has become a human pandemic. Heightened inflammation, vascular hyperpermeability, acute lung injury, coagulopathy, and cardiovascular abnormalities are among the SARS-CoV-2 infection-related complications. Major burn is also associated with metabolic derangements, vascular leak, and hemodynamic instability. Burn patients are at high risk for infections and developing sepsis. COVID-19 in burn victims might worsen the clinical outcome and make their medical management challenging. RESULT: Here, we present four cases of concomitant burn and COVID-19 with different degrees of complications. They had no (three out of four) or multiple (one out of four) baseline comorbidities and all were admitted to hospital for further management. Three out of four cases demonstrated acute respiratory failure and were intubated (no longer than 7 days). It seems that one of them had COVID-19 on arrival, the other apparently contracted at outside hospital, and the last two infected during the index hospitalization. CONCLUSION: Concomitant severe burn and COVID-19 might complicate the clinical presentation and hospital course. Such combination was associated with poor outcome in a case with baseline comorbidities, beyond what was expected from the severity of burn injury. However, a more comprehensive study with larger sample size is required to make a valid conclusion. With an ongoing COVID-19 global pandemic, SARS-CoV-2 infection might be a concurrent disease with other illnesses or traumas such as burn. This dictate multidisciplinary approaches to risk stratify, screen, assess, and manage coexisting diseases. Additionally, appropriate preparations and careful precautions need to be executed in burn units to prevent COVID-19 exposure and transmission to limit potential adverse outcomes.