We appreciate the comments and questions by Piette et al. with regard to our assessment of fungal infections in burn patients as determined by autopsy [1]. As stated by Piette et al., autopsies are rare in the medical community making our 43% autopsy rate a true strength of this cohort for analyzing attributable causes of death. With regard to possible selection or referral bias for patients who underwent an autopsy, autopsies are offered and strongly encouraged for every patient that dies at our burn unit by the entire healthcare team including the nursing staff along with the senior surgeons. Therefore there is minimal referral or selection bias as to who does or does not undergo an autopsy. In addition, we did not attempt to correlate clinical causes of mortality at the time of death, as the intent of the study was to evaluate only autopsy data; studies have shown the enhanced ability of autopsies to delineate causes of death more so than clinical criteria at the time of demise [2,3]. Overall, we do agree with the comments by Piette that one has to be cautious about ascribing definitive causality to fungal infections in this autopsy review, but it is likely the results are more accurate than a clinical assessment of cause of death by the physician at the time of death. It was also not our intent to provide a summary of all-cause mortality in this population, but to focus specifically on fungal infection. A study assessing all-cause mortality including fungal pathogens at this burn unit, reflecting a more recent time period, has been accepted for publication [4].
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