Epidemiology and Infection

Original Papers

Other infections

Combat trauma-associated invasive fungal wound infections: epidemiology and clinical classification

A. C. WEINTROBa1a2, A. B. WEISBRODa1, J. R. DUNNEa3, C. J. RODRIGUEZa1, D. MALONEa1, B. A. LLOYDa4, T. E. WARKENTIENa1, J. WELLSa1, C. K. MURRAYa5, W. BRADLEYa2, F. SHAIKHa2, J. SHAHa2, D. AGGARWALa2, M. L. CARSONa2, D. R. TRIBBLEa2 c1 and the Infectious Disease Clinical Research Program Trauma Infectious Disease Outcomes Study Group

a1 Walter Reed National Military Medical Center, Bethesda, MD, USA

a2 Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

a3 Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA

a4 Landstuhl Regional Medical Center, Landstuhl, Germany

a5 San Antonio Military Medical Center, Fort Sam Houston, TX, USA


The emergence of invasive fungal wound infections (IFIs) in combat casualties led to development of a combat trauma-specific IFI case definition and classification. Prospective data were collected from 1133 US military personnel injured in Afghanistan (June 2009–August 2011). The IFI rates ranged from 0·2% to 11·7% among ward and intensive care unit admissions, respectively (6·8% overall). Seventy-seven IFI cases were classified as proven/probable (n = 54) and possible/unclassifiable (n = 23) and compared in a case-case analysis. There was no difference in clinical characteristics between the proven/probable and possible/unclassifiable cases. Possible IFI cases had shorter time to diagnosis (P = 0·02) and initiation of antifungal therapy (P = 0·05) and fewer operative visits (P = 0·002) compared to proven/probable cases, but clinical outcomes were similar between the groups. Although the trauma-related IFI classification scheme did not provide prognostic information, it is an effective tool for clinical and epidemiological surveillance and research.

(Received November 01 2013)

(Revised January 13 2014)

(Accepted February 15 2014)

(Online publication March 18 2014)

Key words

  • Epidemiology;
  • fungi – infections due to;
  • surveillance


c1 Author for correspondence: D. R. Tribble, MD, DrPH, Scientific Director, Infectious Disease Clinical Research Program, Preventive Medicine & Biometrics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-5119, USA. (Email: David.Tribble@usuhs.edu)


  This material was presented at the Military Health System Research Symposium, 13–16 August 2012, Fort Lauderdale, Florida, USA.