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. 2016 Jun 30;29(2):90-93.

Epidemiology of nosocomial fungal infections in the National Center for Burns in Casablanca, Morocco

A Rafik  1 , M Diouri  1 , N Bahechar  1 , A Chlihi  1
Affiliations

Epidemiology of nosocomial fungal infections in the National Center for Burns in Casablanca, Morocco

A Rafik et al. Ann Burns Fire Disasters. .

Abstract
in English, French

Fungal infection is a leading cause of death in burns patients and incurs significant costs for burn units. Our aim was to determine epidemiology of these infections, and analyze risk factors in the burns intensive care unit of the National Center for Burns and Plastic Surgery at Ibn-Rochd University Hospital, Casablanca. It is a retrospective review of all patients admitted from 2011-2014 who developed cultures positive for fungal organisms. Criteria for nosocomial fungal infections were those of the Center for Disease Control in Atlanta (1988, revised 1992, 2004). Microbiological surveillance was carried out daily. Patient demographic data, % TBSA, type of infection, site(s), species and number of cultures, and risk factors for fungal infections were collected. Mean age of patients was 24.5 +/- 27.3 years; 63% were female. Mean % TBSA was 30.7 +/- 23.4%, and % FTSA was 21.7 +/- 20.1%. Injury due to flame was most common (82%), followed by scald (10%), contact (4%), electrical (3%) and chemical (1%). Incidence of nosocomial fungal infection was 10%. The fungal pathogen most frequently isolated was Candida albicans (65.7%), followed by other Candida species (18.6%). Aspergillus spp was present in 3.9% and was statistically associated with mortality (3.2%) and morbidity. In our study, risk factors for these infections were mostly degree of burn (mean TBSA = 30.7%) and prolonged broad-spectrum antibiotic therapy. These two factors were associated with a higher incidence of multiple positive cultures, and significantly increased mortality (21.6%). Amphotericin B and fluconazole were the most frequently used antifungal agents. Fungi are emerging as important nosocomial pathogens. The main clinical implications are thinking faster about fungi infections and being more careful with antibiotic prescriptions.

Les infections fongiques sont une cause majeure de mortalité chez les brûlés et en augmente significativement le coût de prise en charge. Cette étude a pour buts de déterminer l’épidémiologie et d’analyser les facteurs de risque de leur survenue dans le centre national des brûlés de l’hôpital Ibn-Roch de Casablanca. Il s’agit d’une revue rétrospective des patients hospitalisés entre 2011 et 2014 ayant eu des cultures fongiques positives. Les critères de définition d’une infection fongique nosocomiale (IFN) étaient ceux du CDC d’Atlanta de 1988, révisés en 1992 et 2004. La surveillance microbiologique était journalière. Les données démographiques, la surface atteinte, le type et le (les) sites de l’infection, l’espèce, le nombre de cultures positives on été colligés. Les facteurs de risque de survenue d’une IFN ont été analysés. L’âge était de 25,4 +/- 27,3 ans, 63% des patients étaient des femmes. La surface brûlée était de 30,7 +/- 23,4% dont 21,7 +/- 20,1% profond. Les brûlures par flammes étaient les plus fréquentes (82%), suivies des ébouillantements et des brûlures par contact. L’incidence des IFN était de 10%. Candida albicans y était l’espèce la plus largement représentée (65,7%), suivie par 18,6% de « Candida non albicans ». Aspergillus spp étaient retrouvés dans 3,9% des cas et clairement associés à la mortalité et la morbidité. Les facteurs de risque étaient essentiellement la surface brûlée et l’antibiothérapie à large spectre prolongée. Ils étaient associés à un plus grand nombre de cultures positives multiples et à une surmortalité (21,6%). L’amphotéricine B et le fluconazole étaient les antifongiques les plus prescrits. Les champignons devenant des agents fréquents d’infections nosocomiales, il est nécessaire d’y songer rapidement et de limiter les prescriptions d’antibiotiques.

Keywords: burn intensive care; burns; fungal infection.

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Figures

Table I
Table I. Patient characteristics by fungi positive/complete group
Fig. 1
Fig. 1. Percentage of Candida spp isolated.
Fig. 2
Fig. 2. Incidence of fungal organisms isolated from any site.
Table II
Table II. Frequency of fungal organisms isolated
See this image and copyright information in PMC

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