Combat trauma-associated invasive fungal wound infections: epidemiology and clinical classification

Epidemiol Infect. 2015 Jan;143(1):214-24. doi: 10.1017/S095026881400051X. Epub 2014 Mar 18.


The emergence of invasive fungal wound infections (IFIs) in combat casualties led to development of a combat trauma-specific IFI case definition and classification. Prospective data were collected from 1133 US military personnel injured in Afghanistan (June 2009-August 2011). The IFI rates ranged from 0·2% to 11·7% among ward and intensive care unit admissions, respectively (6·8% overall). Seventy-seven IFI cases were classified as proven/probable (n = 54) and possible/unclassifiable (n = 23) and compared in a case-case analysis. There was no difference in clinical characteristics between the proven/probable and possible/unclassifiable cases. Possible IFI cases had shorter time to diagnosis (P = 0·02) and initiation of antifungal therapy (P = 0·05) and fewer operative visits (P = 0·002) compared to proven/probable cases, but clinical outcomes were similar between the groups. Although the trauma-related IFI classification scheme did not provide prognostic information, it is an effective tool for clinical and epidemiological surveillance and research.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Afghanistan
  • Antifungal Agents / therapeutic use
  • Fungemia / diagnosis
  • Fungemia / drug therapy
  • Fungemia / epidemiology*
  • Humans
  • Male
  • Military Personnel
  • Prognosis
  • United States
  • Wound Infection / complications*
  • Wound Infection / epidemiology*
  • Wounds and Injuries / complications*
  • Young Adult


  • Antifungal Agents