Natural history of bloodstream infections in a burn patient population: the importance of candidemia.
Because of a perceived increase in Candida bloodstream infections in our burn unit, we retrospectively reviewed all the microbiologic data and the medical records of 209 patients with burns admitted during a 42-month period. Twice weekly burn wound cultures demonstrated that Candida species were the tenth most frequently isolated organisms (69/191 patients, 36%). Despite the low frequency of isolation from burn wounds, Candida species were the most common organisms found in blood cultures and urine cultures. Of 49 patients with positive blood cultures, 16 (33%) had clinically significant culture growth of yeasts: Candida albicans, 12; Candida parapsilosis, 2; Candida tropicalis, 1; and Torulopsis glabrata, 1. Patients with candidemia were more likely than patients with blood culture growth of other organisms to have burn wound cultures that grew Candida (15/16 vs 21/33, p = 0.02), larger burns (61% vs 38%, p < 0.001), and death (63% vs 27%, p = 0.02). Multivariate analysis demonstrated that the total number of blood cultures with microorganism growth and large burn size were the greatest independent risk factors for candidemia. These data demonstrate that yeasts are pathogens of major importance in patients with burns, suggesting that in patients with burns who have suspected sepsis and large burn injury or a previous bacteremia, strong consideration should be given to administration of amphotericin B initiation of empiric antibacterial therapy.