Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
Department of Hand, Plastic and Reconstructive Surgery, Burn Trauma Center, BG Trauma Center Ludwigshafen, University of Heidelberg, Heidelberg, Germany.
Surg Infect (Larchmt). 2021 Feb;22(1):83-87. doi: 10.1089/sur.2020.299. Epub 2020 Oct 9.
Fungal burn wound infections are among the most devastating complications in patients who are severely burned. Increasing incidence of burn wound infections caused by fungi led to new challenges in diagnostic and therapeutic approaches. The wide use of broad-spectrum antibiotic agents, an increased prevalence of molds and non- spp., and the variety of available antifungal agents underline the importance of identifying the causative species, to initiate adequate therapy within an adequate timeframe. Review of the pertinent English and German literature. Fungal burn wound infections go along with a delay of identifying the causative fungus species and can be mistaken for early bacterial burn wound infection. Recently, an increase of uncommon fungal pathogens and fungi resistance against antifungal agents has been reported. Amphotericin B and voriconazole remain the antifungal drugs used most commonly. Adequate therapy remains challenging. Early radical debridement and wound closure play an imperative part, particularly in preventing infections caused by yeasts and molds or any other agent. Prophylactic empiric pharmacologic treatment is reserved for those highly at risk for invasive burn wound infection only. Because of the emergence of drug-resistant fungi, the development of new antifungal drugs is essential for the battle against fungal burn wound infections.
真菌感染是严重烧伤患者最严重的并发症之一。真菌感染导致的烧伤创面感染发生率不断增加,给诊断和治疗方法带来了新的挑战。广谱抗生素的广泛应用、霉菌和非 spp. 的流行以及各种可用的抗真菌药物强调了确定致病物种的重要性,以便在适当的时间内启动足够的治疗。
回顾相关的英文和德文文献。真菌感染会导致确定致病真菌物种的时间延迟,并可能被误诊为早期细菌烧伤创面感染。最近,报告了不常见的真菌病原体和真菌对抗真菌药物的耐药性增加。两性霉素 B 和伏立康唑仍然是最常用的抗真菌药物。
适当的治疗仍然具有挑战性。早期彻底清创和伤口闭合至关重要,尤其是在预防酵母和霉菌或任何其他病原体引起的感染方面。预防性经验性药物治疗仅保留给那些有严重侵袭性烧伤创面感染风险的患者。由于耐药真菌的出现,开发新的抗真菌药物对于对抗真菌感染至关重要。