Identification of fungal agents isolated from burn lesions using mycological and molecular methods in patients admitted to Velayat burn hospital in Rasht city during 2022-2023
-
Pegah Ardi
,
Roshanak Daie Ghazvini
,
Seyed Jamal Hashemi
,
Mohammadreza Mobayen
,
Abolfazl Pourheidari
,
Sadegh Khodavaisy
,
Mahdi Abastabar
,
Zahra Rafat
Abstract
Background and Objectives: Fungal burn wound infections (FBWIs) are one of the most disastrous complications in burn patients. The present study investigated the incidence and the species distribution of fungal agents isolated from burn lesions and reviewed the feautures, underlying conditions, and outcomes of patients.
Materials and Methods: The wounds were swabbed and cultured on Sabouraud Dextrose Agar with chloramphenicol medium. Fungal identification was performed using internal transcribed spacer (ITS) and beta-tubulin sequencing.
Results: A total of 380 swab specimens were obtained. Of these, 101 patients (26.75 %) were positive in culture. Among the 101 positive cases, most isolates were from males (n= 68, 67.33%) and most of them were over 30 years old. Flame (n=38, 37.63%) was the predominant cause of burns, and previous history of ICU admission (n=35, 34.66%), presence of central venous catheter (n=25, 24.75%), and diabetes mellitus (n=17, 16.83%) were the main underlying conditions. Candida parapsilosis complex (n=36, 35.64%), and Pichia kudriavzevii (C. krusei) (n=8, 7.92%) represent the most commonly isolated species Also, 2 out of 101 patients (2%) died.
Conclusion: In the present study, non-albicans Candida species were much higher frequent than C. albicans with most cases associated with Candida parapsilosis complex.
1. Palackic A, Popp D, Tapking C, Houschyar KS, Branski LK. Fungal infections in burn patients. Surg Infect (Larchmt) 2021; 22: 83-87.
2. Koyro KI, Bingoel AS, Bucher F, Vogt PM. Burn guidelines—an international comparison. Eur Burn J 2021; 2: 125-139.
3. Maitz J, Merlino J, Rizzo S, McKew G, Maitz P. Burn wound infections microbiome and novel approaches using therapeutic microorganisms in burn wound infection control. Adv Drug Deliv Rev 2023; 196: 114769.
4. Pruskowski KA, Mitchell TA, Kiley JL, Wellington T, Britton GW, Cancio LC. Diagnosis and Management of Invasive Fungal Wound Infections in Burn Patients. Eur Burn J 2021; 2: 168-183.
5. Rafat Z, Ramandi A, Khaki PA, Ansari S, Ghaderkhani S, Haidar H, et al. Fungal and bacterial co-infections of the respiratory tract among patients with COVID-19 hospitalized in intensive care units. Gene Rep 2022; 27: 101588.
6. Azevedo MM, Pina-Vaz C, Rodrigues AG. The role of phage therapy in burn wound infections management: advantages and pitfalls. J Burn Care Res 2022; 43: 336-342.
7. D'Abbondanza JA, Shahrokhi S. Burn infection and burn sepsis. Surg Infect (Larchmt) 2021; 22: 58-64.
8. Ladhani HA, Yowler CJ, Claridge JA. Burn wound colonization, infection, and sepsis. Surg Infect (Larchmt) 2021; 22: 44-48.
9. Jabeen K, Khan M, Umar S, Shaheen N, Farooqi J. Spectrum of fungal pathogens in burn wound specimens: data from a tertiary care Hospital Laboratory in Pakistan. J Burn Care Res 2021; 42: 241-244.
10. Roudbary M, Vahedi-Shahandashti R, Santos ALSD, Roudbar Mohammadi S, Aslani P, Lass-Flörl C, et al. Biofilm formation in clinically relevant filamentous fungi: A therapeutic challenge. Crit Rev Microbiol 2022; 48: 197-221.
11. Li S, Renick P, Senkowsky J, Nair A, Tang L. Diagnostics for wound infections. Adv Wound Care (New Rochelle) 2021; 10: 317-327.
12. Procop GW, Church DL, Hall GS, Janda WM, Koneman EW, Schreckenberger P, et al. Koneman’s Color Atlas and Textbook of Diagnostic Microbiology. 7th ed. Wolters Kluwer Health, Philadelphia, 2017. https://search.worldcat.org/title/Koneman's-color-atlas-and-textbook-of-diagnostic-microbiology/oclc/876002916
13. Topley WWC, Wilson GS, Collier LH, Mahy BWJ, Meulen VT, American Society for Microbiology. Topely & Wilsons. Microbiology and Microbial infections. 10th ed. Hodder Arnold; ASM Press, London, New York, 2005. https://search.worldcat.org/title/Topley-and-Wilson's-microbiology-and-microbial-infections/oclc/651750031
14. Agarwal S, Manchanda V, Verma N, Bhalla P. Yeast identification in routine clinical microbiology laboratory and its clinical relevance. Indian J Med Microbiol 2011; 29: 172-177.
15. Behera HS, Srigyan D. Evaluation of polymerase chain reaction over routine microbial diagnosis for the diagnosis of fungal keratitis. Optom Vis Sci 2021; 98: 280-284.
16. Sevgi M, Toklu A, Vecchio D, Hamblin MR. Topical antimicrobials for burn infections–an update. Recent Pat Antiinfect Drug Discov 2013; 8: 161-197.
17. Horta R, Tomaz D, Egipto P, Silva A. The outcome of fungal infections in a burn intensive care unit: a study of 172 patients. Ann Burns Fire Disasters 2020; 33: 101-106.
18. Andalib E, Faghani M, Zia Ziabari SM, Shenagari M, Salehiniya H, Keivanlou MH, et al. The effectiveness of the anteroom (Vestibule) area on hospital infection control and health staff safety: A systematic review. Front Public Health 2022; 10: 828845.
19. Maurel V, Denis B, Camby M, Jeanne M, Cornesse A, Glavnik B, et al. Outcome and characteristics of invasive fungal infections in critically ill burn patients: a multicenter retrospective study. Mycoses 2020; 63: 535-542.
20. Rafat Z, Sasani E, Salimi Y, Hajimohammadi S, Shenagari M, Roostaei D. The prevalence, etiological agents, clinical features, treatment, and diagnosis of HIV-associated oral candidiasis in pediatrics across the world: a systematic review and meta-analysis. Front Pediatr 2021; 9: 805527.
21. Okuno E, Jarros IC, Bonfim-Mendonça PS, Vicente de Rezende G, Negri M, Svidzinski TE. Candida parapsilosis isolates from burn wounds can penetrate an acellular dermal matrix. Microb Pathog 2018; 118: 330-335.
22. Kamali Sarvestani H, Mahmoudi S, Afarinesh Khaki P, Ansari S, Ghaderkhani S, Roostaei D, et al. Epidemiology, risk factors, species distribution, and antifungal susceptibility of candidemia among hospitalized patients with COVID-19. Curr Med Mycol 2021; 7: 12-18.
23. Pedrosa AF, Rodrigues AG. Candidemia in burn patients: figures and facts. J Trauma 2011; 70: 498-506.
24. Ramos A, Romero Y, Sánchez‐Romero I, Fortun J, Paño JR, Pemán J, et al. Risk factors, clinical presentation and prognosis of mixed candidaemia: a population‐based surveillance in Spain. Mycoses 2016; 59: 636-643.
25. Fochtmann A, Forstner C, Hagmann M, Keck M, Muschitz G, Presterl E, et al. Predisposing factors for candidemia in patients with major burns. Burns 2015; 41: 326-332.
26. Gonçalves SS, Souza ACR, Chowdhary A, Meis JF, Colombo AL. Epidemiology and molecular mechanisms of antifungal resistance in Candida and Aspergillus. Mycoses 2016; 59: 198-219.
27. Sarabahi S, Tiwari VK, Arora S, Capoor MR, Pandey A. Changing pattern of fungal infection in burn patients. Burns 2012; 38: 520-528.
28. Horvath EE, Murray CK, Vaughan GM, Chung KK, Hospenthal DR, Wade CE, et al. Fungal wound infection (not colonization) is independently associated with mortality in burn patients. Ann Surg 2007; 245: 978-985.
29. Bahar MA, Pakyari MR, Gholipourmalekabadi M, Samadikuchaksaraei A. The prevalence of fungal infections in a level I Iranian burn hospital. Asian Biomed 2013; 7: 829-833.
30. Murray CK, Loo FL, Hospenthal DR, Cancio LC, Jones JA, Kim SH, et al. Incidence of systemic fungal infection and related mortality following severe burns. Burns 2008; 34: 1108-1112.
31. Resch TR, Main S, Price LA, Milner SM. A fungal burn infection. Eplasty 2014; 14: ic5.
32. Lago K, Decker CF, Chung KK, Blyth D. Difficult to treat infections in the burn patient. Surg Infect (Larchmt) 2021; 22: 95-102.
33. Church D, Elsayed S, Reid O, Winston B, Lindsay R. Burn wound infections. Clin Microbiol Rev 2006; 19: 403-434.
34. Sharma S, Bajaj D, Sharma P. Fungal infection in thermal burns: a prospective study in a tertiary care centre. J Clin Diagn Res 2016; 10: PC05-PC07.
2. Koyro KI, Bingoel AS, Bucher F, Vogt PM. Burn guidelines—an international comparison. Eur Burn J 2021; 2: 125-139.
3. Maitz J, Merlino J, Rizzo S, McKew G, Maitz P. Burn wound infections microbiome and novel approaches using therapeutic microorganisms in burn wound infection control. Adv Drug Deliv Rev 2023; 196: 114769.
4. Pruskowski KA, Mitchell TA, Kiley JL, Wellington T, Britton GW, Cancio LC. Diagnosis and Management of Invasive Fungal Wound Infections in Burn Patients. Eur Burn J 2021; 2: 168-183.
5. Rafat Z, Ramandi A, Khaki PA, Ansari S, Ghaderkhani S, Haidar H, et al. Fungal and bacterial co-infections of the respiratory tract among patients with COVID-19 hospitalized in intensive care units. Gene Rep 2022; 27: 101588.
6. Azevedo MM, Pina-Vaz C, Rodrigues AG. The role of phage therapy in burn wound infections management: advantages and pitfalls. J Burn Care Res 2022; 43: 336-342.
7. D'Abbondanza JA, Shahrokhi S. Burn infection and burn sepsis. Surg Infect (Larchmt) 2021; 22: 58-64.
8. Ladhani HA, Yowler CJ, Claridge JA. Burn wound colonization, infection, and sepsis. Surg Infect (Larchmt) 2021; 22: 44-48.
9. Jabeen K, Khan M, Umar S, Shaheen N, Farooqi J. Spectrum of fungal pathogens in burn wound specimens: data from a tertiary care Hospital Laboratory in Pakistan. J Burn Care Res 2021; 42: 241-244.
10. Roudbary M, Vahedi-Shahandashti R, Santos ALSD, Roudbar Mohammadi S, Aslani P, Lass-Flörl C, et al. Biofilm formation in clinically relevant filamentous fungi: A therapeutic challenge. Crit Rev Microbiol 2022; 48: 197-221.
11. Li S, Renick P, Senkowsky J, Nair A, Tang L. Diagnostics for wound infections. Adv Wound Care (New Rochelle) 2021; 10: 317-327.
12. Procop GW, Church DL, Hall GS, Janda WM, Koneman EW, Schreckenberger P, et al. Koneman’s Color Atlas and Textbook of Diagnostic Microbiology. 7th ed. Wolters Kluwer Health, Philadelphia, 2017. https://search.worldcat.org/title/Koneman's-color-atlas-and-textbook-of-diagnostic-microbiology/oclc/876002916
13. Topley WWC, Wilson GS, Collier LH, Mahy BWJ, Meulen VT, American Society for Microbiology. Topely & Wilsons. Microbiology and Microbial infections. 10th ed. Hodder Arnold; ASM Press, London, New York, 2005. https://search.worldcat.org/title/Topley-and-Wilson's-microbiology-and-microbial-infections/oclc/651750031
14. Agarwal S, Manchanda V, Verma N, Bhalla P. Yeast identification in routine clinical microbiology laboratory and its clinical relevance. Indian J Med Microbiol 2011; 29: 172-177.
15. Behera HS, Srigyan D. Evaluation of polymerase chain reaction over routine microbial diagnosis for the diagnosis of fungal keratitis. Optom Vis Sci 2021; 98: 280-284.
16. Sevgi M, Toklu A, Vecchio D, Hamblin MR. Topical antimicrobials for burn infections–an update. Recent Pat Antiinfect Drug Discov 2013; 8: 161-197.
17. Horta R, Tomaz D, Egipto P, Silva A. The outcome of fungal infections in a burn intensive care unit: a study of 172 patients. Ann Burns Fire Disasters 2020; 33: 101-106.
18. Andalib E, Faghani M, Zia Ziabari SM, Shenagari M, Salehiniya H, Keivanlou MH, et al. The effectiveness of the anteroom (Vestibule) area on hospital infection control and health staff safety: A systematic review. Front Public Health 2022; 10: 828845.
19. Maurel V, Denis B, Camby M, Jeanne M, Cornesse A, Glavnik B, et al. Outcome and characteristics of invasive fungal infections in critically ill burn patients: a multicenter retrospective study. Mycoses 2020; 63: 535-542.
20. Rafat Z, Sasani E, Salimi Y, Hajimohammadi S, Shenagari M, Roostaei D. The prevalence, etiological agents, clinical features, treatment, and diagnosis of HIV-associated oral candidiasis in pediatrics across the world: a systematic review and meta-analysis. Front Pediatr 2021; 9: 805527.
21. Okuno E, Jarros IC, Bonfim-Mendonça PS, Vicente de Rezende G, Negri M, Svidzinski TE. Candida parapsilosis isolates from burn wounds can penetrate an acellular dermal matrix. Microb Pathog 2018; 118: 330-335.
22. Kamali Sarvestani H, Mahmoudi S, Afarinesh Khaki P, Ansari S, Ghaderkhani S, Roostaei D, et al. Epidemiology, risk factors, species distribution, and antifungal susceptibility of candidemia among hospitalized patients with COVID-19. Curr Med Mycol 2021; 7: 12-18.
23. Pedrosa AF, Rodrigues AG. Candidemia in burn patients: figures and facts. J Trauma 2011; 70: 498-506.
24. Ramos A, Romero Y, Sánchez‐Romero I, Fortun J, Paño JR, Pemán J, et al. Risk factors, clinical presentation and prognosis of mixed candidaemia: a population‐based surveillance in Spain. Mycoses 2016; 59: 636-643.
25. Fochtmann A, Forstner C, Hagmann M, Keck M, Muschitz G, Presterl E, et al. Predisposing factors for candidemia in patients with major burns. Burns 2015; 41: 326-332.
26. Gonçalves SS, Souza ACR, Chowdhary A, Meis JF, Colombo AL. Epidemiology and molecular mechanisms of antifungal resistance in Candida and Aspergillus. Mycoses 2016; 59: 198-219.
27. Sarabahi S, Tiwari VK, Arora S, Capoor MR, Pandey A. Changing pattern of fungal infection in burn patients. Burns 2012; 38: 520-528.
28. Horvath EE, Murray CK, Vaughan GM, Chung KK, Hospenthal DR, Wade CE, et al. Fungal wound infection (not colonization) is independently associated with mortality in burn patients. Ann Surg 2007; 245: 978-985.
29. Bahar MA, Pakyari MR, Gholipourmalekabadi M, Samadikuchaksaraei A. The prevalence of fungal infections in a level I Iranian burn hospital. Asian Biomed 2013; 7: 829-833.
30. Murray CK, Loo FL, Hospenthal DR, Cancio LC, Jones JA, Kim SH, et al. Incidence of systemic fungal infection and related mortality following severe burns. Burns 2008; 34: 1108-1112.
31. Resch TR, Main S, Price LA, Milner SM. A fungal burn infection. Eplasty 2014; 14: ic5.
32. Lago K, Decker CF, Chung KK, Blyth D. Difficult to treat infections in the burn patient. Surg Infect (Larchmt) 2021; 22: 95-102.
33. Church D, Elsayed S, Reid O, Winston B, Lindsay R. Burn wound infections. Clin Microbiol Rev 2006; 19: 403-434.
34. Sharma S, Bajaj D, Sharma P. Fungal infection in thermal burns: a prospective study in a tertiary care centre. J Clin Diagn Res 2016; 10: PC05-PC07.
| Files | ||
| Issue | Vol 16 No 4 (2024) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v16i4.16308 | |
| Keywords | ||
| Wound infection; Burns; Candida parapsilosis complex; Pichia kudriavzevii (Candida krusei); Iran | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Ardi P, Daie Ghazvini R, Hashemi SJ, Mobayen M, Pourheidari A, Khodavaisy S, Abastabar M, Rafat Z. Identification of fungal agents isolated from burn lesions using mycological and molecular methods in patients admitted to Velayat burn hospital in Rasht city during 2022-2023. Iran J Microbiol. 2024;16(4):490-496.
