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

  • A. C. WEINTROB (a1) (a2), A. B. WEISBROD (a1), J. R. DUNNE (a3), C. J. RODRIGUEZ (a1), D. MALONE (a1), B. A. LLOYD (a4), T. E. WARKENTIEN (a1), J. WELLS (a1), C. K. MURRAY (a5), W. BRADLEY (a2), F. SHAIKH (a2), J. SHAH (a2), D. AGGARWAL (a2), M. L. CARSON (a2) and D. R. TRIBBLE (a2)
  • DOI:
  • Published online: 18 March 2014

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.

Corresponding author
*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:
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