Trauma Infectious Disease Outcomes Study (TIDOS) Invasive Fungal Infection (IFI) Case Investigation

Beginning in 2009, military physicians noted increasing frequency of casualties from Operation Enduring Freedom diagnosed with the unexpected complication of invasive fungal wound infections IFI. The Infectious Disease Clinical Research Program at USU studied these cases through TIDOS in conjunction with orthopedic, trauma, and infectious disease services. Findings include a total of 36 cases meeting criteria for proven, probable, or possible infection, with a high of 3.2 percent of trauma admissions in the fourth quarter of 2010 progressive rate increase by the number of Landstuhl ICU admission, reaching a peak rate of 8.0 percent in the 4th quarter of 2010. The majority had suffered blast wounds while on dismounted patrol in Helmand and Kandahar provinces, Afghanistan. Lower extremity amputation occurred in 78 percent of cases. Patients received massive amounts of blood products. Four patients 11 percent died. Recommendations include 1 heightened index of suspicion based on finding of extensive necrosis on serial debridement and risk factors 2 early aggressive tissue sampling 3 aggressive surgical debridement 4 empiric antifungal therapy if strong suspicion for IFI, discontinue if histopath exam negative 5 early ID consultation and 6 coordinate with surgical pathologyclinical microbiology.