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Volume 25, Number 9—September 2019
CME ACTIVITY - Synopsis

Classification of Trauma-Associated Invasive Fungal Infections to Support Wound Treatment Decisions

Anuradha GanesanComments to Author , Faraz Shaikh, William Bradley, Dana M. Blyth, Denise Bennett, Joseph L. Petfield, M. Leigh Carson, Justin M. Wells, David R. Tribble, and Infectious Disease Clinical Research Program Trauma Infectious Disease Outcomes Study Group
Author affiliations: The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, USA (A. Ganesan, F. Shaikh, W. Bradley, D. Bennett, M.L. Carson); Uniformed Services University of the Health Sciences, Bethesda (A. Ganesan, F. Shaikh, W. Bradley, D. Bennett, M.L. Carson, D.R. Tribble); Walter Reed National Military Medical Center, Bethesda (A. Ganesan, J.M. Wells); Brooke Army Medical Center, San Antonio, Texas, USA (W. Bradley, D.M. Blyth); Landstuhl Regional Medical Center, Landstuhl, Germany (J.L. Petfield)

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Table 1

Definitions for the classification of evidence for fungal infections*

Term Definition†
Persistent necrosis‡
 Presence of necrosis after >2 surgical debridements
Persistent laboratory evidence of fungal infection‡
 Presence of positive histopathology and/or culture after >2 surgical debridements
Wounds meeting criteria for IFI
 Includes wounds with persistent necrosis and persistent laboratory evidence of fungal infection
Wounds highly suspicious for fungal infection (high-suspicion wounds)
 Includes wounds that did not meet the criteria for an IFI but produced signs and symptoms suggestive of a deep SSTI ascribed to a fungus (based on the use of antifungals for >10 d and a physician report). Wounds that did not meet criteria for an IFI but required a proximal amputation were included, irrespective of the duration of antifungal use.
Wounds with low suspicion for fungal Infection (low-suspicion wounds) Includes wounds that did not meet the criteria for an IFI and did not meet the criteria for a deep SSTI. This category also includes wounds that produced signs and symptoms of a deep SSTI attributed to bacteria (based on physician report or the use of antifungals for <10 d) but with laboratory evidence of fungus (i.e., positive fungal cultures, histopathologic findings, or both).

*IFI, invasive fungal infection; SSTI, skin and soft tissue infection.
†Centers for Disease Control and Prevention National Healthcare Safety Network criteria for deep SSTIs were adapted for this definition (19).
‡Excludes any additional debridement that was performed in the battlefield hospitals in Afghanistan.

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Page created: August 20, 2019
Page updated: August 20, 2019
Page reviewed: August 20, 2019
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