INVASIVE FUNGAL INFECTIONS (IFI)

Invasive fungal infections were first described in DCBI casualties from Afghanistan during combat operations from 2009 - 2011.25 IFI is associated with continued wound progression and myonecrosis. Patients are at risk for invasive fungal infection if three of the following factors are present:

- Dismounted blast injury
- Above knee immediate amputation
- Extensive perineal/genitourinary/rectal injury
- Ultra massive transfusion of >20 units in the first 24 hours

For these patients, it is recommended that the irrigation solution be switched to high-volume Dakin’s solution. The IFI and blast protocol should be followed. Daily OR trips for wound inspection must occur until there is no further evidence of fungal infection.22

Refer to JTS Invasive Fungal Infection in War Wounds CPG for further guidance.18