Correlation of culture with histopathology in fungal burn wound colonization and infection

An increasing number of burn wound infections are now due to fungi. Historically, therapy of fungal burn wound infections (FWI) consisted of debridement, topical antifungals and/or IV amphotericin B, negating the need to categorize disease further than fungal burn wound colonization (FWC) versus FWI. Newer antifungal agents have varying spectrums of activity, increasing the importance of identifying fungi, often to species. The records of patients admitted to our burn center from April 2000 to March 2005 were reviewed for fungi identified by histopathology. Wound specimens with fungi were classified as FWC or FWI and culture results were compared. The 1515 surgical wound tissue specimens were obtained from 2036 patients. Fungi were detected in the histopathology of 68 patients, 19 with FWI (3.8 FWI/year); 9 had corresponding growth on culture. Forty nine patients were identified with FWC, 16 with fungi recovered in corresponding cultures. FWI was associated with increased mortality (OR 25.3, CI 3.12-204.8). Correlation between histopathologic and culture identification of fungi was inconsistent. The etiology of FWI was diverse; fungi with known resistance to each of the three major classes of antifungals were isolated, suggesting empirical use of one class may be inadequate to treat FWI. Future burn wound management must seek to identify fungal pathogens to species.