Severe fungal infections following blunt traumatic injuries: A 5-year multicenter descriptive study

•These results demonstrate the uncommon, yet challenging diagnosis and management of fungal infection following blunt traumatic injury.•Most patients did not have an underlying illness but developed a severe fungal infection because the skin barrier was compromised, leading to substantial wound contamination and transient immunosuppression.•Fungal infections developed after injuries in geographical regions with high relative humidity, including Texas, Kansas, and Missouri, and no post-traumatic fungal infections were identified in Colorado.•Non-specific infection symptoms, including leukocytosis and fever, typically presented a week after injury, potentially leading to delays in diagnosis and treatment.•Ordering cultures earlier in the patient's stay when these infections symptoms present may help clinicians with more timely treatment of patients with post-traumatic fungal infections. The aggressive and timely treatment of post-traumatic fungal infections is the most efficacious way to reduce morbidity and mortality. Compared to the military trauma population, studies reporting on fungal infections in civilian trauma are not well described. The purpose of this study was to describe characteristics of civilian trauma patients who developed fungal infections and to identify common risk factors and report any delays between injury and treatment. This was a five-year (1/1/2013–3/1/2018) retrospective, descriptive study across six level 1 trauma centers. All consecutively admitted trauma patients (≥18 years) with laboratory-confirmed fungal wound infections were included. Patients with solely candida wound isolates were excluded. Patient demographics, clinical wound and infection characteristics, organisms cultured, treatment modalities, length of stay, in-hospital mortality, and any diagnostic or treatment delays were described. Of the 54,521 trauma patients screened for fungal infection, 12 were identified. All patients suffered major injuries after blunt trauma (abbreviated injury score 3–5) and sustained wound contamination, and in nine patients, the cause of injury was motor vehicle. Six had open wounds/fractures on admission. The geographical region with the highest rate of fungal infection was Texas (n = 7), followed by Kansas (N = 3), then Missouri (N = 2). First symptoms of infection (leukocytosis or fever (n = 10)) presented a median of 6.3 (4.1–9.8) days after injury. Wound management entailed a combination of debridements (n = 8), negative pressure