Accession Number : ADA620318


Title :   Antifungal Wound Penetration of Amphotericin and Voriconazole in Combat-related Injuries: Case Report


Descriptive Note : Journal article


Corporate Author : ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX


Personal Author(s) : Akers, Kevin S ; Rowan, Matthew P ; Niece, Krista L ; Graybill, John C ; Mende, Katrin ; Chung, Kevin K ; Murray, Clinton K


Full Text : https://apps.dtic.mil/dtic/tr/fulltext/u2/a620318.pdf


Report Date : 15 Apr 2015


Pagination or Media Count : 8


Abstract : Survivors of combat trauma can have long and challenging recoveries, which may be complicated by infection. Invasive fungal infections are a rare but serious complication with limited treatment options. Currently, aggressive surgical debridement is the standard of care, with antifungal agents used adjunctively with uncertain efficacy. Anecdotal evidence suggests that antifungal agents may be ineffective in the absence of surgical debridement, and studies have yet to correlate antifungal concentrations in plasma and wounds. Here we report the systemic pharmacokinetics a nd wound effluent antifungal concentrations of five wounds from two male patients, aged 28 and 30 yea rs old who sustained combat-related blast injuries in southern Afghanistan, with proven or possible invasive fungal infection. Our data demonstrate that while voriconazole sufficiently penetrated the wound resulting in detectable effluent levels, free amphotericin B (unbound to plasma) was not present in wound effluent despite sufficient concentrations in circulating plasma. In addition, considerable between-patient and within-patient variability was observed in antifungal pharmacokinetic parameters. These data highlight the need for further studies evaluating wound penetration of commonly used antifungals and the role for therapeutic drug monitoring i n providing optimal care for critically ill and injured war fighters.


Descriptors :   *EXTREMITIES , *FUNGICIDES , *MILITARY PERSONNEL , *WOUNDS AND INJURIES , AFGHANISTAN CONFLICT , AMPHOTERICIN , BLAST , BLOOD PLASMA , BLOOD TRANSFUSION , CASE STUDIES , CASUALTIES , CLINICAL MEDICINE , CONCENTRATION(CHEMISTRY) , DIAGNOSIS(MEDICINE) , FUNGUS DISEASES , INFECTIOUS DISEASES , MILITARY OPERATIONS , NECROSIS , OPTIMIZATION , PATIENTS , PHARMACOKINETICS , SURGERY , SURVIVAL(PERSONNEL) , TRAUMA , WARFARE


Subject Categories : Anatomy and Physiology
      Medicine and Medical Research
      Weapons Effects(biological)
      Pharmacology
      Military Forces and Organizations


Distribution Statement : APPROVED FOR PUBLIC RELEASE