Prevalence of fungal colonization and infection of burn wounds among inpatients and associated factors at Mulago Hospital

Abstract

Background: Burn injuries are on increase worldwide including Uganda. Infections are the commonest cause of morbidity and mortality in burn patients. The prophylactic use of antibiotics in burn patients has reduced bacterial burn wound sepsis while fungal colonization and infection of burn wounds has increased. While the reported prevalence of fungal colonization and infection of burn wounds is upto 42% and 10% respectively in other centres, it is unknown in Mulago Hospital. Several patient, environmental and clinical factors have been demonstrated to be associated with burn wound fungal colonization. Study Objective: To establish the prevalence and factors associated with burn wound fungal colonization and infection among inpatients at Mulago Hospital. Methods: This cross sectional study was carried out at Mulago Hospital Burns Unit and enrolled patients admitted with burn injuries. Burn wound biopsies were taken for fungal culture to isolate the fungal species. The specimens were also subjected to histopathological assessment to determine invasive fungal infection. Results: Out of 103 burn patients recruited in the study, 51 patients (49.5%) had fungal colonized burn wounds and histological evidence of fungal infection was seen in 7 patients (6.8%). Aspergillus species was isolated from 35.3% and Candida Albicans in 31.4%. Other species included Candida Tropicalis (25.5%), other non-Albican Candida (15.7%) and Penicillium (5.9%). Of the seven biopsies with fungal infection, 3 did not grow any fungi on culture while Candida Albicans, Aspergillus and Candida Tropicalis were isolated from the other 4 patients. TBSA of burn >30% and wound age of over 2 weeks were the independent factors associated with fungal colonization of burn wounds. Conclusions and Recommendations: The prevalence of burn wound fungal colonization in Mulago Hospital burns unit is among the highest at 49.5% with Aspergillus and Candida Albicans being the most prevalent species. A prospective study should be done to investigate the outcome of patients with fungal colonized or infected wounds and to evaluate antifungal empirical therapy in patients with TBSA >30% and wound age >2 weeks. There is need to establish the source of fungi to plan preventive measures to reduce the prevalence of fungal colonization and infection.