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)
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.