Impact of Mucorales and Other Invasive Molds on Clinical Outcomes of Polymicrobial Traumatic Wound Infections

Warkentien, Tyler; Shaikh, Faraz; Weintrob, Amy; Rodríguez, Carlos J.; Murray, Clinton K.; Lloyd, Bradley A.; Ganesan, Anuradha; Aggarwal, Deepak; Carson, M. Leigh; Tribble, David R.

doi:10.1128/jcm.00835-15

Cited by 35 publications

(34 citation statements)

References 20 publications

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“…The vast majority of soldiers with post-traumatic IFI are injured by explosions during dismounted patrol, leading to severe injuries and intensive medical interventions (Table 1) (Radowsky et al, 2015;Lewandowski et al, 2016;Warkentien et al, 2015). Description of wound characteristics in these patients is often limited to the presence or absence of necrosis, and recurrent necrosis was a requirement for inclusion in most studies to better Rüping et al (2009) 4 Warkentien et al (2012) Reference citations refer to the original list of references in the full manuscript.…”

Section: Militarymentioning

confidence: 99%

“…Delays between injury, diagnosis, and treatment are welldescribed as significant drivers of patient outcomes. In the military setting, the average time between injury and date of first positive culture was six days, corresponding to an average delay of 3-10 days between injury and diagnosis (Paolino et al, 2012;Lloyd et al, 2014;Warkentien et al, 2015). Meanwhile, 7-15 days passed between injury and initiation of antifungal therapy; this delay was reduced to four days when measured from sample acquisition (Warkentien et al, 2012;Paolino et al, 2012;Lloyd et al, 2014).…”

Section: Militarymentioning

confidence: 99%

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Invasive Fungal Infections Secondary to Traumatic Injury

Kronen

Liang

Bochicchio

et al. 2017

International Journal of Infectious Diseases

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Invasive fungal infection (IFI) is a rare but serious complication of traumatic injury. The purpose of this article is to review the epidemiology, natural history, mycology, risk factors, diagnosis, treatment, and outcomes associated with post-traumatic IFI in military and civilian populations. The epidemiology of post-traumatic IFI is poorly characterized, but incidence appears to be rising. Patients often suffer from severe injuries and require extensive medical interventions. Fungi belonging to the order Mucorales are responsible for most post-traumatic IFI in both civilian and military populations. Risk factors differ between these cohorts but include specific injury patterns and comorbidities. Diagnosis of post-traumatic IFI typically follows positive laboratory results in the appropriate clinical context. The gold standard of treatment is surgical debridement in addition to systemic antifungal therapy. Patients with post-traumatic IFI may be at greater risk of amputation, delays in wound healing, hospital complications, and death as compared to trauma patients who do not develop IFI. More research is needed to understand the factors surrounding the development and management of post-traumatic IFI to reduce the significant morbidity and mortality associated with this disease.

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Section: Militarymentioning

confidence: 99%

Section: Militarymentioning

confidence: 99%

Invasive Fungal Infections Secondary to Traumatic Injury

Kronen

Liang

Bochicchio

et al. 2017

International Journal of Infectious Diseases

View full text Add to dashboard Cite

show abstract

“…Of note, the treatment of post-traumatic mould infections is further complicated by the fact that many wounds may grow different moulds [63]. For example, combinations of Mucorales, Aspergillus spp., and Fusarium spp.…”

Section: Treatmentmentioning

confidence: 99%

“…NA, not available. Comprehensive summaries of management of post-traumatic mould wound injuries in previous decades and in burn patients are available elsewhere [13,34] *Some cases of burn or postoperative mould wound infections were also included (4/16) **Cohort overlapping with that of other studies investigating different aspects of combat-related injuries [10,21,24,50,63] ***Possible cross-transmission…”

Section: Treatmentmentioning

confidence: 99%

Mould Infections of Traumatic Wounds: A Brief Narrative Review

et al. 2020

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Mould infections may follow traumatic injuries, with direct fungal inoculum in the site of injury and subsequent angioinvasion, possibly resulting in tissue necrosis and systemic dissemination. The pathogenesis of mould infections following trauma injuries presents unique features compared with classical mould infections occurring in neutropenic or diabetic patients, because a large fraction of post-traumatic mould

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“…Germination is key to the pathogenesis of Mucormycetes, leading to tissue penetration, endothelial angioinvasion, and vessel thrombosis, ultimately resulting in debilitating necrosis (Ibrahim et al 2012). Traumatic and burn wound infections, including military-associated blast wounds, are known predisposing conditions for mucormycosis in the immunocompetent (Roden et al 2005), with over 70% of these infections being polymicrobial in nature (Warkentien et al 2015; Akers et al 2014). Pseudomonas aeruginosa , Staphylococcus aureus , and Escherichia coli are the most commonly co-isolated bacterial species from chronic wounds (Gjødsbøl et al 2006; Kalan et al 2016), and are therefore likely to interact and compete with Mucorales spores.…”

Section: Introductionmentioning

confidence: 99%

Pseudomonas aeruginosainhibitsRhizopus microsporusgermination through sequestration of free environmental iron

Kousser

Clark

Voelz

et al. 2018

Preprint

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Rhizopus spp are the most common etiological agents of mucormycosis, causing over 90% mortality in disseminated infection. Key to pathogenesis is the ability of fungal spores to swell, germinate, and penetrate surrounding tissues. Antibiotic treatment in at-risk patients increases the probability of the patient developing mucormycosis, suggesting that bacteria have the potential to control the growth of the fungus. However, research into polymicrobial relationships involving Rhizopus spp has not been extensively explored. Here we show that co-culturing Rhizopus microsporus and Pseudomonas aeruginosa results in the inhibition of spore germination. This inhibition was mediated via the secretion of bacterial siderophores, confirming the essential role of iron for fungal growth. Addition of P. aeruginosa siderophores to R. microsporus spores in the zebrafish larval model of infection resulted in inhibition of fungal germination and reduced host mortality. Therefore, during infection antibacterial treatment may relieve bacterial imposed nutrient restriction resulting in secondary fungal infections.

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Impact of Mucorales and Other Invasive Molds on Clinical Outcomes of Polymicrobial Traumatic Wound Infections

Cited by 35 publications

References 20 publications

Invasive Fungal Infections Secondary to Traumatic Injury

Invasive Fungal Infections Secondary to Traumatic Injury

Mould Infections of Traumatic Wounds: A Brief Narrative Review

Pseudomonas aeruginosainhibitsRhizopus microsporusgermination through sequestration of free environmental iron

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