Table 4. Microbiological findings for US military patients who had battlefield trauma wounds with invasive fungal infections and laboratory evidence of fungal infection, June 1, 2009–December 31, 2014*.
| Culture findings | IFI wounds, n = 143 | High-suspicion wound, n = 120 | p value† | Low-suspicion wound, n = 150 | p value‡ |
|---|---|---|---|---|---|
| Fungal cultures not sent |
9 (6.3) |
3 (2.5) |
0.235 |
2 (1.3) |
0.032 |
| Fungal growth§ | |||||
| None | 21 (14.7) | 16 (13.5) | 0.774 | 9 (6.0) | 0.014 |
| 1 fungus | 55 (38.5) | 50 (41.7) | 0.597 | 91 (60.7) | <0.001 |
| >1 fungi | 58 (40.6) | 51 (42.5) | 0.751 | 48 (32.0) | 0.128 |
| >1 fungi plus bacteria¶ | 82 (57.3) | 80 (66.7) | 0.121 | 83 (55.3) | 0.729 |
| Order Mucorales | 55 (38.5) | 26 (21.7) | 0.003 | 13 (8.7) | <0.001 |
| Aspergillus spp. | 45 (31.5) | 39 (32.5) | 0.858 | 55 (36.7) | 0.348 |
| Fusarium spp. | 24 (16.8) | 20 (16.7) | 0.980 | 6 (4.0) | <0.001 |
| Other filamentous fungi# |
19 (13.3) |
27 (22.7) |
0.046 |
69 (45.7) |
<0.001 |
| Bacterial growth§ | |||||
| None | 3 (2.1) | 1 (0.8) | 0.628 | 3 (2.0) | ≈1.00 |
| Staphylococcus aureus** | 0 | 0 | NA | 2 (1.3) | 0.499 |
| Enterococcus spp. | 53 (37.1) | 51 (42.5) | 0.369 | 42 (28.0) | 0.098 |
| E. faecalis | 5 (3.5) | 5 (4.2) | 0.777 | 8 (5.3) | 0.445 |
| E. faecium | 41 (28.7) | 42 (35.0) | 0.271 | 31 (20.7) | 0.111 |
| Escherichia coli | 22 (15.4) | 20 (16.7) | 0.777 | 23 (15.3) | 0.990 |
| Pseudomonas spp. | 21 (14.7) | 23 (19.2) | 0.332 | 16 (10.7) | 0.301 |
| P. aeruginosa | 16 (11.2) | 14 (11.7) | 0.903 | 11 (7.3) | 0.254 |
| Acinetobacter baumannii | 29 (20.3) | 11 (9.2) | 0.012 | 6 (4.0) | <0.001 |
| Other gram-negative bacilli | 30 (21.0) | 29 (24.2) | 0.537 | 21 (14.0) | 0.115 |
| ESKAPE pathogen†† | 49 (34.3) | 50 (41.7) | 0.217 | 44 (29.3) | 0.365 |
| Multidrug resistant‡‡ | 53 (37.1) | 34 (28.3) | 0.134 | 26 (17.3) | <0.001 |
*Values are no. (%) except as indicated. IFI, invasive fungal infection; NA, not applicable. †Compares characteristics between IFI and high-suspicion wounds. ‡Compares characteristics between IFI and low-suspicion wounds. §Because of polymicrobial wounds, organisms are not mutually exclusive and will add to more than the total. Bacterial cultures were restricted to those collected within 14 d of injury. ¶Category of >1 fungi plus bacteria is not mutually exclusive from fungal cultures with 1 fungus or >1 fungi. #Includes Acrophialophora spp., Alternaria spp., Bipolaris spp., Scedosporium spp., and Trichoderma. **Includes methicillin-resistant and methicillin-susceptible S. aureus. ††ESKAPE pathogens are Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. ‡‡Multidrug resistant is defined as resistance to ≥3 of 4 antibiotic classes or producion of extended-spectrum β-lactamase or carbapenemases.