Prevalence, species distribution, and risk factors of fungal colonization and infection in patients at a burn intensive care unit in Vietnam

Document Type : Original Articles

Authors

1 Department of Heamatology, Toxicology, Radiation and Occupational Diseases. Military Hospital 103. Vietnam Military Medical University.

2 Department of Medical Education, Military Hospital 103, Vietnam Military Medical University

3 Scientific and Training Management Department, National Institute of Malaria, Parasitology and Entomology, Nam Tu Liem, Ha Noi, Vietnam

4 Intensive Care Unit, National Hospital of Burn, Vietnam Military Medical University, Ha Dong, Ha Noi, Vietnam

5 National Hospital of Burn, Vietnam Military Medical University, Ha Dong, Ha Noi, Vietnam

6 Department of Parasitology, Vietnam Military Medical University, Phung Hung, Ha Dong, Ha Noi, Vietnam

7 Department of Microbiology, National Hospital of Burn, Vietnam Military Medical University, Ha Dong, Ha Noi, Vietnam

8 Department of Microbiology and Pathogens, Institute of Biomedicine and Pharmacy, Vietnam Military Medical University, Ha Dong, Ha Noi, Vietnam

9 Department of Parasitology, Vietnam Military Medical University, Ha Dong, Ha Noi, Vietnam

10.18502/cmm.6.3.4664

Abstract

Background and Purpose: Burn patients are at a higher risk of infections caused by different organisms. This study aimed to address the prevalence, causative species, and factors related to fungal colonization or infection in patients with acute severe injuries admitted to the intensive care unit (ICU) of a burn hospital in northern Vietnam.
Materials and Methods: This prospective study was conducted on 400 patients in a burn ICU between 2017 and 2019. Clinical samples were weekly collected and screened for fungi, and relevant clinical information was obtained from medical records.
Results: According to the results, 90% of the patients were colonized with fungi. Out of this group, 12.75% of the cases had invasive fungal infection (IFI). Eleven yeasts and six mold species were isolated from the patients, with the most common species being Candida tropicalis (45.56%) and C. albicans (41.94%). Among the eleven species causing fungal wound infection (FWI), the most common agents were Candida (66.7% of FWI patients) and Aspergillus (38.5%) species. Three Candida species isolated from blood were C. tropicalis (66.7%), C. albicans (20.0%), and C. parapsilosis (14.3%). No factors were found to expose the patients to a higher risk of fungal colonization. However, hyperglycemia, prolonged ICU stay, and heavy Candida species colonization were found to be independently predictive of IFI.
Conclusion: Burn patients are at the risk of fungal infection with Candida species (especially C. tropicalis) and Aspergillus as the most frequently responsible agents. Continuous surveillance of fungi and appropriate management of pathophysiological consequences are essential to prevent fungal infection in burn patients.
 
 

Keywords

References

1. World Health Organization. Burns. Geneva: World Health Organization; 2018.
2. Church D, Elsayed S, Reid O, Winston B, Lindsay R. Burn wound infections. Clin Microbiol Rev. 2006; 19(2):403-34.
3. Cochran A, Morris S, Edelman L, Saffle J. Systemic Candida infection in burn patients: a case-control study of management patterns and outcomes. Surg Infect. 2002; 3(4):367-74.
4. Struck MF, Gille J. Fungal infections in burns : a comprehensive review. Ann Burns Fire Disasters. 2013; 26(3):147-53.
5. Capoor MR, Sarabahi S, Tiwari VK, Narayanan RP. Fungal infections in burns: diagnosis and management. Indian J Plast Surg. 2010; 43(Suppl):S37-42.
6. Lachiewicz AM, Hauck CG, Weber DJ, Cairns BA, van Duin D. Bacterial infections after burn injuries: impact of multidrug resistance. Clin Infect Dis. 2017; 65(12):2130-6.
7. Gupta N, Haque A, Lattif AA, Narayan RP, Mukhopadhyay G, Prasad R. Epidemiology and molecular typing of Candida isolates from burn patients. Mycopathologia. 2004; 158(4): 397-405.
8. Mousa H, Al-Bader S, Hassan D. Correlation between fungi isolated from burn wound and burn care units. Burns. 1999; 25(2):145-7.
9. Garcia-Hermoso D, Criscuolo A, Lee SC, Legrand M, Chaouat M, Denis B, et al. Outbreak of invasive wound mucormycosis in a burn unit due to multiple strains of mucor circinelloides f. circinelloides resolved by whole-genome sequencing. mBio. 2018; 9(2):e00573-18.
10. Cornely O, Alastruey-Izquierdo A, Arenz D, Chen SC, Dannaoui E, Hochhegger B, et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis. 2019; 19(12):e405-21.
11. Sarabahi S, Tiwari VK, Arora S, Capoor MR, Pandey A. Changing pattern of fungal infection in burn patients. Burns. 2011; 38(4):520-8.
12. Atiyeh B, Masellis A, Conte C. Optimizing burn treatment in developing low- and middle-income countries with limited health care resources (Part 1). Ann Burn Fire Disasters. 2009; 22(3):121-5.
13. Wallace AB. The exposure treatment of burns. Lancet. 1951; 1(6653):501-4.
14. Knaus W, Zimmerman J, Wagner D, Draper EA, Lawrence DE. APACHE-acute physiology and chronic health evaluation: a physiologically based classification system. Crit Care Med. 1981; 9(8):591-7.
15. Greenhalgh DG, Saffle JR, Holmes JH 4th, Gamelli RL, Palmieri TL, Horton JW, et al. American burn association consensus conference to define sepsis and infection in burns. J Burn Care Res. 2007; 28(6):776-90.
16. Leaw SN, Chang HC, Sun HF, Barton R, Bouchara JP, Chang TC. Identification of medically important yeast species by sequence analysis of the internal transcribed spacer regions. J Clin Microbiol. 2006; 44(3):693-9.
17. Horvath E, Murray C, Vaughan G, Chung KK, Hospenthal DR, Wade CE, et al. Fungal wound infection (not colonization) is independently associated with mortality in burn patients. Ann Surg. 2007; 245(6):978-85.
18. Pittet D, Monod M, Suter PM, Frenk E, Auckenthaler R. Candida colonization and subsequent infections in critically Ill surgical patients. Ann Surg. 1994; 220(6):751-8.
19. Bellomo R, Ronco C, Kellum JA, Mehta RL, Palevsky P; Acute dialysis quality initiative workgroup. acute renal failure - definition, outcome measures, animal models, fluid therapy and information technology needs: the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group. Crit Care. 2004; 8(4):R204-12.
20. Rhodes A, Evans L, Alhazzani W, Levy MM, Antonelli M, Ferrer R, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Intensive Care Med. 2017; 43(3):304-77.
21. Arabi Y, Venkatesh S, Haddad S, Al Shimemeri A, Al Malik S. A prospective study of prolonged stay in the intensive care unit: predictors and impact on resource utilization. Int J Qual Heal Care. 2002; 14(5):403-10.
22. Ostrosky-zeichner L. Invasive mycoses : diagnostic challenges. Am J Med. 2012; 125(1 Suppl):S14-24.
23. De Pauw B, Walsh TJ, Donnelly JP, Stevens DA, Edwards JE, Calandra T, et al. Revised definitions of invasive fungal disease
from the European Organization for Research and Treatment of Cancer/ Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG). Clin Infect Dis. 2008; 46(12): 1813-21.
24. Lam NN, Huong HT, Tuan CA. Mass burn injuries: an analysis of characteristics and outcomes in a developing country. Ann Burn Fire Disasters. 2017; 30(3):210-3.
25. Tian H, Wang L, Xie W, Shen C, Guo G, Liu J, et al. Epidemiologic and clinical characteristics of severe burn patients: results of a retrospective multicenter study in China, 2011-2015. Burn Trauma. 2018; 6:14.
26. Li H, Yao Z, Tan J, Zhou J, Li Y, Wu J, Luo G. Epidemiology and outcome analysis of 6325 burn patients: a five-year retrospective study in a major burn center in Southwest China. Sci Rep. 2017; 7:46066.
27. Mundhada SG, Waghmare PH, Rathod PG, Ingole KV. Bacterial and fungal profle of burn wound infections in Tertiary Care Center. Indian J Burns. 2015; 23(1):71-5.
28. Smolle C, Cambiaso-Daniel J, Forbes AA, Wurzer P, Hundeshagen G, Branski LK, et al. Recent trends in burn epidemiology worldwide: a systematic review. Burns. 2017; 43(2):249-57.
29. Caggiano G, Puntillo F, Coretti C, Giglio M. Candida colonization index in patients admitted to an ICU. Int J Mol Sci. 2011; 12(10):7038-47.
30. Cole GT, Halawa AA, Anaissie EJ. The role of the gastrointestinal tract in hematogenous candidiasis : from the laboratory to the bedside. Clin Infect Dis. 1996; 22(Suppl 2):S73-88.
31. Bahar MA, Pakyari MR, Gholipourmalekabadi M, Samadikuchaksaraei A. The prevalence of fungal infections in a level I Iranian burn hospital. Asian Biomed. 2013; 7(6):829-33.
32. Spebar M, Pruitt BJ. Candidiasis in the burned patient. J Trauma. 1981; 21(3):237-9.
33. Ha JF, Italiano CM, Heath CH, Shih S, Rea S, Wood FM. Candidemia and invasive candidiasis : A review of the literature for the burns surgeon. Burns. 2011; 37(2):181-95.
34. Vinsonneau C, Benyamina M, Baixench MT, Stephanazzi J, Augris C, Grabar S, et al. Effects of candidaemia on outcome of burns. Burns. 2009; 35(4):561-4.
35. Bassetti M, Giacobbe DR, Vena A, Trucchi C, Ansaldi F, Antonelli M, et al. Incidence and outcome of invasive candidiasis in intensive care units (ICUs) in Europe: results of the EUCANDICU project. Crit Care. 2019; 23(1):219.
36. Ghrenassia E, Mokart D, Mayaux J, Demoule A, Rezine I, Kerhuel L, et al. Candidemia in critically ill immunoco-mpromised patients: report of a retrospective multicenter cohort study. Ann Intensive Care. 2019; 9(1):62.
37. Fochtmann A, Forstner C, Hagmann M, Keck M, Muschitz G, Presterl E, et al. Predisposing factors for candidemia in patients with major burns. Burns. 2015; 41(2):326-32.
38. Fitzwater J, Purdue GF, Hunt JL, O’Keefe GE. The risk factors and time course of sepsis and organ dysfunction after burn trauma. J Trauma Acute Care Surg. 2003; 54(5):959-66.
39. Ballard JL, Edelman L, Saffle J, Sheridan R, Kagan R, Bracco D, et al. Positive fungal cultures in burn patients: a multicenter review. J Burn Care Res. 2008; 29(1):213-21.
40. Rafik A, Diouri M, Bahechar N, Chlihi A. Epidemiology of nosocomial fungal infections in the National center for burns in Casablanca, Marocco. Ann Burns Fire Disasters. 2016; 29(2):90-3.
41. Bac ND, Anh LT, Quang LB, Luc NK, Nga TT, Nagi M, et al. Prevalence of Candida bloodstream isolates from patients in two hospitals in Vietnam. Iran J Microbiol. 2019; 11(2):108-13.
42. Beyda ND, Chuang SH, Alam MJ, Shah DN, Ng TM, McCaskey L, et al. Treatment of Candida famata bloodstream infections: case series and review of the literature. J Antimicrob Chemother. 2013; 68(2):438-43.
43. Boatto HF, Cavalcanti SD, Del Negro GM, Girão MJ, Francisco EC, Ishida K, et al. Candida duobushaemulonii: an emerging rare pathogenic yeast isolated from recurrent vulvovaginal candidiasis in Brazil. Mem Inst Oswaldo Cruz. 2016; 111(6):407-10.
44. Ramos R, Caceres D, Perez M, Garcia N, Castillo W, Santiago E, et al. Emerging multidrug-resistant Candida duobushaemulonii infections in Panama hospitals: importance of laboratory surveillance and accurate identification. J Clin Microbiol. 2018; 56(7):e00371.
45. Hou X, Xiao M, Chen S, Wang H, Cheng JW, Chen XX, et al. Identification and antifungal susceptibility profiles of Candida haemulonii species complex clinical isolates from a multicenter study in China. J Clin Microbiol. 2016; 54(11):2676-80.
46. Chakrabarti A, Rudramurthy S, Kale P, Hariprasath P, Dhaliwal M, Singhi S, et al. Epidemiological study of a large cluster of fungaemia cases due to Kodamaea ohmeri in an Indian tertiary care centre. Clin Microbiol Infect. 2014; 20(2):O83-9.
47. Ibrahim N, Amer T. Frequency of bacterial and fungal infections of burn wounds at cairo university burn center. Egypt J Med Microbiol. 2008; 17(4):573-83.
48. Guinea J, de Viedma DG, Peláez T, Escribano P, Muñoz P, Meis JF, et al. Molecular epidemiology of aspergillus fumigatus : an in- depth genotypic analysis of isolates involved in an outbreak of invasive Aspergillosis downloaded from http://jcm.asm.org/ on September 30 , 2018 by guest. J Clin Microbiol. 2011; 49(10):3498-503.
49. Enoch DA, Yang H, Aliyu SH, Micallef C. The changing epidemiology of invasive fungal infections. Methods Mol Biol. 2017; 1508:17-65.
50. Muhammed M, Coleman J, Carneiro H, Mylonakis E. The challenge of managing fusariosis. Virulence. 2011; 2(2):91-6.
51. Lass-Florl C, Cuenca-Estrella M. Changes in the epidemiological landscape of invasive mold infections and disease. J Antimicrob Chemother. 2017; 72(Suppl 1):i5-11.
52. Goyal NK, Gore MA, Goyal RS. Fungal colonisation in burn wounds : an Indian scenerio. Indian J Surg. 2010; 72(1):49-52.
53. Sharma S, Bajaj D, Sharma P. Fungal infection in thermal burns: a prospective study in a tertiary care centre. J Clin Diagn Res. 2016; 10(9):PC05-7.
54. Hedderwick SA, Lyons MJ, Liu M, Vazquez JA, Kauffman CA. Epidemiology of yeast colonization in the intensive care unit. Eur J Clin Microbiol Infect Dis. 2000; 19(9):663-70.
55. Jeschke MG, Chinkes DL, Finnerty CC, Kulp G, Suman OE, Norbury WB, et al. Pathophysiologic response to severe burn
injury. Ann Surg. 2008; 248(3):387-401.
56. Hemmila MR, Taddonio MA, Arbabi S, Maggio PM, Wahl WL. Intensive insulin therapy is associated with reduced infectious complications in burn patients. Surgery. 2008; 144(4):629-37.
57. Paramythiotou E, Frantzeskaki F, Flevari A, Armaganidis A. Invasive fungal infections in the ICU: how to approach, how to treat. Molecules. 2014; 19(1):1085-119.
58. Shoham S, Han G, Granek T, Walsh T, Magee MF. Association between blood glucose levels and development of candidemia in hospitalized patients. Endocr Pract. 2009; 15(2):111-5.
59. Sydnor ERM, Perl TM. Hospital epidemiology and infection control in acute-care settings. Clin Microbiol Rev. 2011; 24(1):141-73.
60. Karacaer Z, Oncul O, Turhan V, Gorenek L, Ozyurt M. A surveillance of nosocomial candida infections: epidemiology and influences on mortalty in intensive care units. Pan Afr Med J. 2014; 19:398.
61. Prasad R. Candida albicans: cellular and molecular biology. Berlin, Germany: Springer; 2017 .
62. Rüping MJ, Vehreschild JJ, Cornely DO. Patients at high risk of invasive fungal infections : when and how to treat. Drugs. 2008; 68(14):1941-58.
63. Eggimann P, Ostrosky-Zeichner L. Early antifungal intervention strategies in ICU patients. Curr Opin Crit Care. 2010; 16(5):465-9.
64. Perlroth J, Choi B, Spellberg B. Nosocomial fungal infections: epidemiology, diagnosis, and treatment. Med Mycol. 2007; 45(4):321-46.
65. Yapar N. Epidemiology and risk factors for invasive candidiasis. Ther Clin Risk Manag. 2014; 10:95-105.
66. Raz-Pasteur A, Hussein K, Finkelstein R, Ullmann Y, Egozi D. Blood stream infections (BSI) in severe burn patients--early and late BSI: a 9-year study. Burns. 2013; 39(4):636-42.
67. Van Burik JA, Colven R, Spach DH. Cutaneous aspergillosis. J Clin Microbiol. 1998; 36(11):3115-21.
68. Renau Escrig AI, Salavert M, Vivó C, Cantón E, Pérez del Caz MD, et al. Candidemia in major burns patients. Mycoses. 2016; 59(6):391-8.
Current Medical Mycology
Volume 6, Issue 3
September 2020
Pages 42-49

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History

  • Receive Date: 19 August 2020
  • Revise Date: 14 October 2020
  • Accept Date: 21 October 2020
  • First Publish Date: 21 October 2020

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