Invasive Fungal Infection Increases Mortality Risk After Burn Injury

Abstract

While invasive fungal infections (IFIs) can be deadly for any hospitalized patient, a high-risk subset are those with burn injuries due to their immunocompromised state, and an increasing number of non-Candida infections have been on the rise. This novel study captures data from across the United States using a multi-institutional dataset derived from electronic health record data and is the largest study to date evaluating mortality associated with fungal infections in burn injury. Inclusion criteria identified all patients with burn injury from 2002 to 2024; IFI was defined as a diagnosis of fungal mycosis with systemic antifungal treatment which was compared to a control cohort of burn patients without mycoses or antifungal treatment. The cohorts were then propensity-matched for gender, age, and percent total body surface area (%TBSA). The unmatched fungal infection cohort contained 3325 patients while the control cohort contained 50 5421. After propensity matching, the 1-year mortality rate for all burn patients with fungal infection was 18.5% compared to 1.9% in controls (risk ratio: 9.8, 95% confidence interval, 7.2-13.2; P < .0001). Additionally, when stratified by %TBSA there was a stepwise increase in mortality: 21.6% for <10% TBSA (P < .0001), 29.0% for 10%-49% TBSA (P < .0001), and 33.1% for >50% TBSA (P = .2). The 3 most common and deadly infections among all burn patients were Aspergillus, invasive Candida, and unspecified mycoses. In all burns, fungal infection was associated with a nearly 10-fold increase in mortality. An incremental increase is noted when stratified by %TBSA and even <10% TBSA burns have an over 20% risk of mortality.

Keywords: burn injury; invasive fungal infection; mortality; total body surface area.