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Article ; Online: Infections in Burn Patients.

Kiley, John L / Greenhalgh, David G

2023 Volume 103, Issue 3, Page(s) 427–437

Abstract: Infections are the leading cause of mortality in burn patients who survive their initial resuscitation. Burn injury leads to immunosuppression and a dysregulated inflammatory response which can have a prolonged impact. Early surgical excision along with ... ...

Abstract	Infections are the leading cause of mortality in burn patients who survive their initial resuscitation. Burn injury leads to immunosuppression and a dysregulated inflammatory response which can have a prolonged impact. Early surgical excision along with support of the multidisciplinary burn team has improved mortality in burn patients. The authors review diagnostic and therapeutic challenges as well as strategies for management of burn related infections.
MeSH term(s)	Humans ; Burns/complications ; Burns/therapy ; Wound Infection/etiology ; Wound Infection/therapy
Language	English
Publishing date	2023-04-04
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	215713-5
ISSN	1558-3171 ; 0039-6109
ISSN (online)	1558-3171
ISSN	0039-6109
DOI	10.1016/j.suc.2023.02.005
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Article ; Online: Letter to the Editor concerning Akhavan AA et al., Invasive non-Candida fungal infections in acute burns-a 13-year review of a single institution and review of the literature.

Cancio, Leopoldo C / Pruskowski, Kaitlin A / Kiley, John L / Glenn, Keith R / How, Remealle A

Journal of burn care & research : official publication of the American Burn Association

2024

Language	English
Publishing date	2024-03-01
Publishing country	England
Document type	Editorial ; Comment
ZDB-ID	2224246-6
ISSN	1559-0488 ; 1559-047X
ISSN (online)	1559-0488
ISSN	1559-047X
DOI	10.1093/jbcr/irae034
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Article ; Online: Epidemiology, clinical characteristics, and outcomes of nontuberculous mycobacterial skin, soft tissue, and bone infections from a single center over a 10-year period.

Ford, Mary B / Okulicz, Jason F / Salinas, Jesse R / Kiley, John L

Journal of clinical tuberculosis and other mycobacterial diseases

2023 Volume 33, Page(s) 100403

Abstract: Introduction: Non-tuberculous mycobacteria (NTM) cause a wide variety of clinical syndromes. Data guiding diagnosis and treatment of NTM skin and soft tissue infections (SSTI) and bone infections are limited. We sought to better understand SSTI and bone ...

Abstract	Introduction: Non-tuberculous mycobacteria (NTM) cause a wide variety of clinical syndromes. Data guiding diagnosis and treatment of NTM skin and soft tissue infections (SSTI) and bone infections are limited. We sought to better understand SSTI and bone infections caused by NTM. Methods: All NTM clinical isolates recovered at Brooke Army Medical Center from 2012 to 2022 were screened; SSTI and bone isolates were included. Electronic health records were reviewed for epidemiologic, microbiologic, and clinical data. Infections were defined as recovery of one or more NTM isolate from skin, soft tissue, or bone cultures with a corresponding clinical syndrome. Results: Forty isolates of skin, soft tissue, or bone origin from 29 patients were analyzed. Twenty (69 %) patients, majority female (14/20, 70 %), had infecting isolates, most commonly secondary to surgery (35 %) or trauma (35 %). Six of 20 (30 %) had bone infections. Time from symptom onset to isolate recovery was a median 61 days (IQR 43-95). Eight (40 %) had combined medical/surgical therapy, 8 (40 %) had surgery alone, and 4 (20 %) had medical therapy alone. Conclusions: Data supporting diagnosis and treatment decisions in NTM SSTI/bone infections is sparse. In this study the majority of NTM isolated were true infections. We confirm that surgery and trauma are the most common routes of exposure. The delay between symptom onset and directed therapy and the wide variety of treatment regimens highlight a need for additional studies delineating criteria for diagnosis and treatment.
Language	English
Publishing date	2023-10-21
Publishing country	England
Document type	Journal Article
ISSN	2405-5794
ISSN (online)	2405-5794
DOI	10.1016/j.jctube.2023.100403
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Article ; Online: Viral Infections in Burns.

Kiley, John L / Chung, Kevin K / Blyth, Dana M

Surgical infections

2020 Volume 22, Issue 1, Page(s) 88–94

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Antiviral Agents/therapeutic use ; Burns/drug therapy ; Burns/epidemiology ; Burns/immunology ; Burns/virology ; COVID-19/epidemiology ; Cytomegalovirus Infections/drug therapy ; Cytomegalovirus Infections/epidemiology ; Herpesviridae Infections/diagnostic imaging ; Herpesviridae Infections/epidemiology ; Humans ; Immunocompromised Host/immunology ; Inflammation Mediators/metabolism ; Retrospective Studies ; Roseolovirus Infections/drug therapy ; Roseolovirus Infections/epidemiology ; SARS-CoV-2 ; Virus Diseases/drug therapy ; Virus Diseases/epidemiology ; Virus Diseases/mortality
Chemical Substances	Antiviral Agents ; Inflammation Mediators
Keywords	covid19
Language	English
Publishing date	2020-05-27
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	1440120-4
ISSN	1557-8674 ; 1096-2964
ISSN (online)	1557-8674
ISSN	1096-2964
DOI	10.1089/sur.2020.130
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Article ; Online: Osteosarcoma of the skull base presenting as a petrocavernous pseudoaneurysm and masquerading as an intracranial abscess: illustrative case.

Washington, Nyomi R / Kiley, John L / Bakken, Hans / Morton, Ryan

Journal of neurosurgery. Case lessons

2021 Volume 2, Issue 1, Page(s) CASE20148

Abstract: Background: Telangiectatic osteosarcoma (TOS) is a rare and aggressive high-grade malignant neoplasm composed of blood-filled or empty cystic spaces resembling aneurysmal bone cysts. Uncommonly, TOSs can occur in the skull base.: Observations: The ... ...

Abstract	Background: Telangiectatic osteosarcoma (TOS) is a rare and aggressive high-grade malignant neoplasm composed of blood-filled or empty cystic spaces resembling aneurysmal bone cysts. Uncommonly, TOSs can occur in the skull base. Observations: The authors present a case of a TOS that presented as a petrocavernous carotid pseudoaneurysm and then masqueraded as an intracranial abscess. The prognosis for TOSs with intracranial involvement is typically unfavorable and inversely related to the degree of intracranial involvement. Lessons: Skull-based malignancies should be part of the differential diagnosis for a rapidly progressing lesion. Recovery of polymicrobial organisms during endoscopic sinus surgery should prompt reconsideration of the differential diagnosis. Postinflammatory changes from endovascular coiling have been described and can confound imaging and clinical findings.
Language	English
Publishing date	2021-07-05
Publishing country	United States
Document type	Case Reports
ISSN	2694-1902
ISSN (online)	2694-1902
DOI	10.3171/CASE20148
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Article ; Online: Mental and Physical Health-Related Quality of Life Following Military Polytrauma.

McDonald, Jay R / Wagoner, Matthew / Shaikh, Faraz / Sercy, Erica / Stewart, Laveta / Knapp, Emma R / Kiley, John L / Campbell, Wesley R / Tribble, David R

Military medicine

2024

Abstract: Introduction: The long-term impact of deployment-related trauma on mental and physical health-related quality of life (HRQoL) among military personnel is not well understood. We describe the mental and physical HRQoL among military personnel following ... ...

Abstract	Introduction: The long-term impact of deployment-related trauma on mental and physical health-related quality of life (HRQoL) among military personnel is not well understood. We describe the mental and physical HRQoL among military personnel following deployment-related polytrauma after their discharge from the hospital and examine factors associated with HRQoL and longitudinal trends. Materials and methods: The U.S. military personnel with battlefield-related trauma enrolled in the Trauma Infectious Diseases Outcomes Study were surveyed using SF-8 Health Surveys at 1 month post-discharge (baseline) and at follow-up intervals over 2 years. Inclusion in the longitudinal analysis required baseline SF-8 plus responses during early (3 and/or 6 months) and later follow-up periods (12, 18, and/or 24 months). Associations of demographics, injury characteristics, and hospitalization with baseline SF-8 scores and longitudinal changes in SF-8 scores during follow-up were examined. Survey responses were used to calculate the Mental Component Summary score (MCS) and the Physical Component Summary score (PCS). The MCS focuses on vitality, mental health, social functioning, and daily activity limitations, whereas PCS is related to general health, bodily pain, physical functioning, and physical activity limitations. Longitudinal trends in SF-8 scores were assessed using chi-square tests by comparing the median score at each timepoint to the median 1-month (baseline) score, as well as comparing follow-up scores to the immediately prior timepoint (e.g., 6 months vs. 3 months). Associations with the 1-month baseline SF-8 scores were assessed using generalized linear regression modeling and associations with longitudinal changes in SF-8 were examined using generalized linear regression modeling with repeated measures. Results: Among 781 enrollees, lower baseline SF-8 total scores and PCS were associated with spinal and lower extremity injuries (P < .001) in the multivariate analyses, whereas lower baseline MCS was associated with head/face/neck injuries (P < .001). Higher baseline SF-8 total was associated with having an amputation (P = .009), and lower baseline SF-8 total was also associated with sustaining a traumatic brain injury (TBI; P = .042). Among 524 enrollees with longitudinal follow-up, SF-8 scores increased, driven by increased PCS and offset by small MCS decreases. Upward SF-8 total score and PCS trends were associated with time post-hospital discharge and limb amputation (any) in the multivariate analyses (P < .05), whereas downward trends were independently associated with spinal injury and developing any post-discharge infection (P ≤ .001). Patients with lower extremity injuries had lower-magnitude improvements in PCS over time compared to those without lower extremity injuries (P < .001). Upward MCS trend was associated with higher injury severity (P = .003) in the multivariate analyses, whereas downward trends were independently associated with having a TBI (P < .001), time post-hospital discharge (P < .001), and occurrence of post-discharge infections (P = .002). Conclusions: Overall, HRQoL increased during the 2-year follow-up period, driven by PCS improvement. Increasing HRQoL was associated with time since hospital discharge and limb amputation, whereas a downward trend in HRQoL was associated with spinal injury and post-discharge infection. The longitudinal decline in MCS, driven by TBI occurrence, time since hospital discharge, and developing post-discharge infections, emphasizes the importance of longitudinal mental health care in this population.
Language	English
Publishing date	2024-02-28
Publishing country	England
Document type	Journal Article
ZDB-ID	391061-1
ISSN	1930-613X ; 0026-4075
ISSN (online)	1930-613X
ISSN	0026-4075
DOI	10.1093/milmed/usae055
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Article ; Online: Seasonality of Microbiology of Combat-Related Wounds and Wound Infections in Afghanistan.

Soderstrom, Matthew A / Blyth, Dana M / Carson, M Leigh / Campbell, Wesley R / Yabes, Joseph M / Shaikh, Faraz / Stewart, Laveta / Tribble, David R / Murray, Clinton K / Kiley, John L

Military medicine

2023 Volume 188, Issue Suppl 6, Page(s) 304–310

Abstract: Introduction: Battlefield-related wound infections are a significant source of morbidity among combat casualties. Seasonality of these infections was demonstrated in previous conflicts (e.g., Korea) but has not been described with trauma-related health ... ...

Abstract	Introduction: Battlefield-related wound infections are a significant source of morbidity among combat casualties. Seasonality of these infections was demonstrated in previous conflicts (e.g., Korea) but has not been described with trauma-related health care-associated infections from the war in Afghanistan. Methods: The study population included military personnel wounded in Afghanistan (2009-2014) medevac'd to Landstuhl Regional Medical Center and transitioned to participating military hospitals in the United States with clinical suspicion of wound infections and wound cultures collected ≤7 days post-injury. Analysis was limited to the first wound culture from individuals. Infecting isolates were collected from skin and soft-tissue infections, osteomyelitis, and burn soft-tissue infections. Data were analyzed by season (winter [ December 1-February 28/29], spring [March 1-May 31], summer [June 1-August 31], and fall [September 1-November 30]). Results: Among 316 patients, 297 (94.0%) sustained blast injuries with a median injury severity score and days from injury to initial culture of 33 and 3.5, respectively. Although all patients had a clinical suspicion of a wound infection, a diagnosis was confirmed in 198 (63%) patients. Gram-negative bacilli (59.5% of 316) were more commonly isolated from wound cultures in summer (68.1%) and fall (67.1%) versus winter (43.9%) and spring (45.1%; P < .001). Multidrug-resistant (MDR) Gram-negative bacilli (21.8%) were more common in summer (21.8%) and fall (30.6%) versus winter (7.3%) and spring (19.7%; P = .028). Findings were similar for infecting Gram-negative bacilli (72.7% of 198)-summer (79.5%) and fall (83.6%; P = .001)-and infecting MDR Gram-negative bacilli (27.3% of 198)-summer (25.6%) and fall (41.8%; P = .015). Infecting anaerobes were more common in winter (40%) compared to fall (11%; P = .036). Gram-positive organisms were not significantly different by season. Conclusion: Gram-negative bacilli, including infecting MDR Gram-negative bacilli, were more commonly recovered in summer/fall months from service members injured in Afghanistan. This may have implications for empiric antibiotic coverage during these months.
MeSH term(s)	Humans ; United States/epidemiology ; Afghanistan/epidemiology ; Wound Infection/drug therapy ; Wound Infection/epidemiology ; Wound Infection/microbiology ; Gram-Negative Bacteria ; Antibiotic Prophylaxis ; Soft Tissue Infections ; Military Personnel ; Wounds and Injuries/epidemiology
Language	English
Publishing date	2023-11-10
Publishing country	England
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, Non-P.H.S.
ZDB-ID	391061-1
ISSN	1930-613X ; 0026-4075
ISSN (online)	1930-613X
ISSN	0026-4075
DOI	10.1093/milmed/usad115
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Article: Viral Infections in Burns

Kiley, John L / Chung, Kevin K / Blyth, Dana M

Surg. infect.,(Larchmt.)

Abstract: Background: Viral infections after burns are less common than bacterial infections but usually occur in the more severely burned patients and have been associated with poor outcomes. Methods: Retrospective reviews and case series were examined to provide ...

Abstract	Background: Viral infections after burns are less common than bacterial infections but usually occur in the more severely burned patients and have been associated with poor outcomes. Methods: Retrospective reviews and case series were examined to provide an overview of the management of viral infections in the burn patient. Results: The most common viral pathogens in these patients are the herpesviruses, which include herpes simplex, varicella zoster, cytomegalovirus, and human herpesvirus 6. Established viral infections that may complicate patient management include human immunodeficiency virus, hepatitis B and C, and, more recently, the novel coronavirus SARS-CoV-2. Herpesvirus infections can occur as primary or nosocomial pathogens but clinical manifestations most commonly are re-activation of latent viral infection. Because of the paucity of data in the burn population, much of the evidence for specific treatments is extrapolated from patients with severe immunosuppression or critical illness. Antiviral therapy is employed for the burn patient with herpesvirus infections. This is an area of active study, and further research is needed to better understand the risks, clinical manifestations, and attributable morbidity and mortality of viral infections. Conclusions: Major burn injury results in immunosuppression and viral infection in a small number of patients. Recognition and antiviral therapy are employed, but additional studies are necessary to improve outcomes in these patients.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #401234
Database	COVID19

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Article ; Online: Emergency Physicians: Beware of the Consent Standard of Care.

Moore, Gregory P / Matlock, Aaron G / Kiley, John L / Percy, Katherine D

Clinical practice and cases in emergency medicine

2018 Volume 2, Issue 2, Page(s) 109–111

Abstract: Many emergency physicians view informed consent as a necessary component of treatments or procedures to be performed on their patients. When such procedures are necessary, often there is a discussion of risks, benefits and alternatives with forms signed ... ...

Abstract	Many emergency physicians view informed consent as a necessary component of treatments or procedures to be performed on their patients. When such procedures are necessary, often there is a discussion of risks, benefits and alternatives with forms signed to validate the discussion. Two Wisconsin emergency department medical-legal cases have expanded liability of the duty of informed consent. These cases have focused on withholding medication and diagnostic tests.
Language	English
Publishing date	2018-04-05
Publishing country	United States
Document type	Case Reports
ISSN	2474-252X
ISSN (online)	2474-252X
DOI	10.5811/cpcem.2018.1.37822
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Article: Deep cutaneous Trichosporon asahii infection in a patient recovering from toxic epidermal necrolysis

Kiley, John L / Zack, Jason / Ritchie, Simon / Krauland, Kevin / Markelz, Elizabeth

Medical mycology case reports. 2019 Mar., v. 23

2019

Abstract: Patients with toxic epidermal necrolysis, a condition that causes full thickness epidermal necrosis that affects over 30% of the skin surface and mucosal membranes, often develop comorbid infections throughout the recovery of the disease [1]. While most ... ...

Abstract	Patients with toxic epidermal necrolysis, a condition that causes full thickness epidermal necrosis that affects over 30% of the skin surface and mucosal membranes, often develop comorbid infections throughout the recovery of the disease [1]. While most commonly these are related to a bacterial source, infections due to viral, mycobacterial, and rarely fungal organisms occur. We present a case of a patient who developed a deep cutaneous fungal infection caused by Trichosporon asahii and discuss the management.
Keywords	Trichosporon asahii ; case studies ; fungi ; mycology ; necrosis ; patients ; toxicity
Language	English
Dates of publication	2019-03
Size	p. 26-28.
Publishing place	Elsevier B.V.
Document type	Article
ISSN	2211-7539
DOI	10.1016/j.mmcr.2018.10.003
Database	NAL-Catalogue (AGRICOLA)

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