Fungal super-infections turn killer in burns cases
NEW DELHI: Fungal infections have been found to be a significant cause of death in burns cases, a new study has revealed. Ironically, these infections result from the use of powerful third-generation antibiotics that destroy all bacteria while allowing fungi present in the environment and the gastrointestinal tract to grow unchecked.
A study by doctors at Safdarjung Hospital, published in the medical journal ‘Burns’, shows 12 out of 100 burn injury patients included in the research had fungal infection. The mortality rate among the infected patients was found to be 66.7%. Most of the patients found positive for fungal infection were on three or more higher antibiotics, given either as a combination or over a period of 10 days. “Of this, the commonest were carbapenems and monobactums followed by Piperacillin and Tazobactum,” states the report. Safdarjung Hospital has the largest dedicated burns unit in Asia with an average of 2000 admissions every year.
One of the lead authors of the study, who did not want to be named, said the ubiquity of fungi in the environment along with the suppression of normal bacteria causes the fungal super-infection in burns. “The broad spectrum antibiotics destroy bacteria which grow on the dead tissues in the wound area. But the fungi, which are present in the system, get a chance to proliferate. They turn pathogenic, leading to infection and even death,” he said. Extreme age groups – children and the elderly – diabetes, inhalation injury, prolonged hospital stay and other risk factors increase the chances of fungal infection in the wound.
Experts say that till a few years ago, the burnt surface was considered to be a suitable site for opportunistic colonization and invasion by bacteria which could be checked by early wound excision and skin grafting and the use of antibiotic therapy. But now, anti-fungal therapy is being mulled in view of the increasing incidence of fungal infection in patients.
A senior doctor said, “A lot of effort has been put into treating life threatening bacterial septicemia in burns but often the bacterial culture is negative yet the patient’s condition deteriorates. Fever, sepsis and even death occur as a consequence. No attention was paid towards the cause of this increasing mortality for a long time. Our investigations suggest that all such patients are usually suffering from fungal infection, and this was confirmed with positive biopsy results. Early closure of wound can be effective in fighting this and decreasing the risk.”