Introduction: Invasive fungal infection remains one of the most morbid problems facing the burned patient.

Background: Our center had previously reported a 10-year experience with fungal burn wound infections from 1979-1989. The overall mortality rate from all fungal infections was 75%. In this study, mucormycosis occurred in 9.0 per 1000 burn admissions. Previous case reports of mucormycosis suggest an extremely high mortality with this condition. The impact of modern antifungal agents and burn wound care on the incidence and mortality of mucormycosis is unclear.

Methods: From January 2003 to November 2009, a case series of patients admitted to our adult burn center who were diagnosed with mucormycosis during their admission was assembled.

Results: During the period of interest, 2453 patients were admitted to the burn center. Of these patients, 15 were diagnosed with mucormycosis (6.1 per 1000 admissions). The median age of these patients was 23 (IQR 22-25), and the median total burn surface area (TBSA) was 56 (IQR 43-72). Of the 15, 12 were military wounds from Operations Enduring Freedom and Iraqi Freedom and the remaining 3 were civilian patients. These patients were diagnosed by physical examination of wounds with wound biopsy and culture of concerning wounds. The extremities were the most frequent site of involvement (66% of cases), followed by head and neck (33%) and trunk (27%). One patient with an open abdomen developed mucormycosis of the small bowel and colon; however, no patients had evidence of disseminated mucormycosis. These wounds were treated with antifungal therapy in 93%, local debridement alone in 67%, and debridement with amputation in 27%. One patient was transitioned to comfort care based on the diagnosis of mucormycosis and died. Overall, the mortality in patients with mucormycosis was 73% with 45% of the deaths attributed to the fungal infection. There did not appear to be an association between treatment modality and overall or fungal-related mortality. TBSA appears associated with mortality with survivors having a low TBSA (0% to 36%) compared to non-survivors (50% to 93%).

Conclusion: The incidence of mucormycosis has decreased at our institution over the last 20 years (6.1 vs. 9.0 per 1000 burn admissions). However, the overall mortality is unchanged (73% vs. 75%). Mortality directly attributable to mucormycosis is significantly less than total mortality with many patients dying from other causes (e.g., gram negative sepsis). Aggressive surgical debridement to include amputation was not associated with improved outcomes.

Becker W, et al. Fungal Burn Wound Infection. Arch Surg 1991;126:44-48).