Invasive Fungal Infection Increases Civilian Mortality Risk After Trauma and Burn Injury

Abstract Introduction Invasive fungal infections (IFI) are increasingly diagnosed in trauma and burn patients with serious, often deadly prognosis. Most knowledge comes from military data or small case series. This study captures a generalizable view of civilian IFI after trauma and burn injury using a multi-institutional database to evaluate incidence, mortality and associated injuries. Methods Using TriNetX database, we identified patients with traumatic and burn injury (traumatic amputations, open fractures and burns) from 2002-2025. IFI was defined as fungal mycosis diagnosis with systemic antifungal treatment, compared to controls without mycoses or antifungal treatment. Cohorts were propensity score matched (1:1) for demographics and 1-year in-hospital mortality was compared to determine risk ratios, 95% confidence intervals and significance. Subgroup analyses examined injury type, mechanism and fungal infection type. Results The traumatic injury cohort contained 97 384 patients; controls contained 9 297 567, with IFI incidence of 1.05%. For all traumatic and burn injuries, 1-year in-hospital mortality with IFI was 3.13% versus 1.08% in controls (RR 2.91, p.0001). When stratified by injury type with IFI, significantly higher mortality risk was found for burn injuries (RR 7.96, incidence 0.46%, p.0001), traumatic amputations (RR 3.32, incidence 1.91%, p.0001) and traumatic open fractures (RR 1.62, incidence 0.95%, p=.01) compared to respective cohorts without IFI. Conclusions In this two-decade civilian study, overall IFI incidence after traumatic injury is 1% with three-fold increased mortality. Burn injury shows eight-fold mortality increase with IFI, traumatic amputations three-fold, and open fractures less than two-fold. Given these significant mortality rates, clinicians must maintain high suspicion for IFI in traumatic injuries, warranting further investigation to determine which patients would benefit from prophylaxis and aggressive treatment. Applicability of Research to Practice This study provides multi-institutional evidence for IFI risk stratification in civilian trauma, identifying injury types requiring heightened surveillance and intervention strategies. Funding for the study N/A.