A review of invasive fungal infections in a single center burn ICU

Naomi Hauser; Tina Palmieri

Infection is the leading cause of death among patients admitted to the burn ICU and invasive mould infection is predictive of poor patient outcome. Patient factors such as age, comorbidities, and burn size contribute to the development of invasive mould infection and patient outcome. In California and other western states, wildfires are becoming and increasingly recognized risk factor for fungal exposure. We aimed to investigate the characteristics and risk factors associated the development of invasive mould infection in patients admitted to the burn ICU at our tertiary care center in Northern California, with specific focus on genus of mould identified, type of skin grafting, and mechanism of burn injury.

We have two main hypotheses for the present study. First, we hypothesize that many patients who developed invasive mould infections are admitted during wildfire season. Second, we hypothesize that many of the patients will have undergone allografting for their burns.

We reviewed all patients admitted to the burn ICU at UC Davis Hospital and developed an invasive mould infection between September 2017 and August 2022 who are not currently still admitted to the hospital for their initial burn injury. 

There were 46 patients admitted to the burn ICU over the defined timeframe who developed mould infections and who are not currently still admitted for their initial burn injury. The average age of patients in the study was 40 years old, with a range of 19-76 years old. Twelve patients died over their admission. The average burn size was 52% with a range of 1-90% total body surface area burned. The month of August saw the largest number of admissions (nine) over the five years. The most common genus identified was Aspergillus (29 isolates) followed by Fusarium (19 isolates). The most common mechanisms of burn were vehicle and gasoline fires (nine patients each) followed by wildfires (six patients) and house fires (five patients). Out of the 46 patients in the study, 44 underwent autografting and 42 underwent allografting at some point during their hospital stay. All patients underwent some sort of skin graft.

Although the significance of invasive mould infections on burn patient outcomes has been investigated there is a deficit of research into the risk factors for these infections. We have found that the most common month for admission to our burn ICU is August, which is a high wildfire incidence month in California. Additionally, wildfires were the third leading cause of burn in patients admitted over our time period. The relationship between mould infections in burn patients and environmental factors at the time of burn can have real clinical significance and should be further investigated.