Top

Clinical Orthopaedics and Related Research®

Published in:

01-06-2008 | Symposium: Papers Presented at the 2007 Meeting of the Musculoskeletal Infection Society

Multidrug-resistant Organisms in Military Wounds from Iraq and Afghanistan

Authors: Jason H. Calhoun, MD, FACS, Clinton K. Murray, MD, FIDSA, Maj., M. M. Manring, PhD

Published in: Clinical Orthopaedics and Related Research® | Issue 6/2008

Abstract

Mortality from battlefield wounds has historically declined, thanks to better surgical management, faster transport of casualties, and improved antibiotics. Today, one of the major challenges facing U.S. military caregivers is the presence of multidrug-resistant organisms in orthopaedic extremity wounds. The most frequently identified resistant strains of bacteria are Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Acinetobacter calcoaceticus-baumannii complex. Overuse of broad-spectrum antibiotics may be an important factor in building resistant strains. Acinetobacter infections appear to hospital-acquired and not from an initial colonization of the injury. More research is required to give military physicians the tools they require to reduce the infection rate and defeat multidrug-resistant organisms.

Acinetobacter baumannii infections among patients at military medical facilities treating injured U.S. service members, 2002–2004. MMWR Morb Mortal Wkly Rep. 2004;53:1063–1066.

Albrecht MC, Griffith ME, Murray CK, Chung KK, Horvath EE, Ward JA, Hospenthal DR, Holcomb JB, Wolf SE. Impact of Acinetobacter infection on the mortality of burn patients. J Am Coll Surg. 2006;203:546–550.PubMedCrossRef

Allen DM, Hartman BJ. Acinetobacter species. In: Mandell GL, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases. Vol 2. Philadelphia, PA: Churchill Livingstone; 2000:2339–2344.

Alvarez-Lerma F. Modification of empiric antibiotic treatment in patients with pneumonia acquired in the intensive care unit. ICU-Acquired Pneumonia Study Group. Intensive Care Med. 1996;22:387–394.PubMedCrossRef

Barnea Y, Carmeli Y, Gur E, Kuzmenko B, Gat A, Neville LF, Eren R, Dagan S, Navon-Venezia S. Efficacy of antibodies against the N-terminal of Pseudomonas aeruginosa flagellin for treating infections in a murine burn wound model. Plast Reconstr Surg. 2006;117:2284–2291.PubMedCrossRef

Barnea Y, Carmeli Y, Kuzmenko B, Gur E, Hammer-Munz O, Navon-Venezia S. The establishment of a Pseudomonas aeruginosa-infected burn-wound sepsis model and the effect of imipenem treatment. Ann Plast Surg. 2006;56:674–679.PubMedCrossRef

Bi L, Hu Y, Fan H, Meng G, Liu J, Li D, Lv R. Treatment of contaminated bone defects with clindamycin-reconstituted bone xenograft-composites. J Biomed Mater Res B Appl Biomater. 2007;82:418–427.PubMed

Bratzler DW. Use of antimicrobial prophylaxis for major surgery: baseline results from the National Surgical Infection Prevention Project. Arch Surg. 2005;140:174–182.PubMedCrossRef

Bratzler DW, Houck PM. Antimicrobial prophylaxis for surgery: an advisory statement from the National Surgical Infection Prevention Project. Clin Infect Dis. 2004;38:1706–1715.PubMedCrossRef

10.

Calhoun JH, Crist BD, Della Rocca GJ, Yin LY. Modification of an Accepted Animal Model of Osteomyelitis to Simulate and Evaluate Treatment of War Extremity Wounds. Columbia, Mo.: U.S. Army Institute of Surgical Research; 2006:10–11.

11.

Davis KA, Moran KA, McAllister CK, Gray PJ. Multidrug-resistant Acinetobacter extremity infections in soldiers. Emerg Infect Dis. 2005;11:1218–1224.PubMed

12.

DeWaal HL. Wound infection. A preliminary note on a combined clinical and bacteriological investigation of 708 wounds. Edinburgh Med J. 1943;L:577–589.

13.

Dougherty PJ, Carter PR, Seligson D, Benson DR, Purvis JM. Orthopaedic surgery advances resulting from World War II. J Bone Joint Surg Am. 2004;86:176–181.PubMed

14.

Eastridge BJ, Jenkins D, Flaherty S, Schiller H, Holcomb JB. Trauma system development in a theater of war: experiences from Operation Iraqi Freedom and Operation Enduring Freedom. J Trauma. 2006;61:1366–1372; discussion 1372–1363.PubMed

15.

Garnacho-Montero J, Garcia-Garmendia JL, Barrero-Almodovar A, Jimenez-Jimenez FJ, Perez-Paredes C, Ortiz-Leyba C. Impact of adequate empirical antibiotic therapy on the outcome of patients admitted to the intensive care unit with sepsis. Crit Care Med. 2003;31:2742–2751.PubMedCrossRef

16.

Garnacho-Montero J, Ortiz-Leyba C, Jimenez-Jimenez FJ, Barrero-Almodovar AE, Garcia-Garmendia JL, Bernabeu-Wittel IM, Gallego-Lara SL, Madrazo-Osuna J. Treatment of multidrug-resistant Acinetobacter baumannii ventilator-associated pneumonia (VAP) with intravenous colistin: a comparison with imipenem-susceptible VAP. Clin Infect Dis. 2003;36:1111–1118.PubMedCrossRef

17.

Garzoni C, Emonet S, Legout L, Benedict R, Hoffmeyer P, Bernard L, Garbino J. Atypical infections in tsunami survivors. Emerg Infect Dis. 2005;11:1591–1593.PubMed

18.

Gawande A. Casualties of war–military care for the wounded from Iraq and Afghanistan. N Engl J Med. 2004;351:2471–2475.PubMedCrossRef

19.

Gondusky JS, Reiter MP. Protecting military convoys in Iraq: an examination of battle injuries sustained by a mechanized battalion during Operation Iraqi Freedom II. Mil Med. 2005;170:546–549.PubMed

20.

Griffith ME, Ceremuga JM, Ellis MW, Guymon CH, Hospenthal DR, Murray CK. Acinetobacter skin colonization of US Army Soldiers. Infect Control Hosp Epidemiol. 2006;27:659–661.PubMedCrossRef

21.

Griffith ME, Lazarus DR, Mann PB, Boger JA, Hospenthal DR, Murray CK. Acinetobacter skin carriage among US army soldiers deployed in Iraq. Infect Control Hosp Epidemiol. 2007;28:720–722.PubMedCrossRef

22.

Hardaway RM. 200 years of military surgery. Injury. 1999;30:387–397.PubMedCrossRef

23.

Hardaway RM. Wound shock: a history of its study and treatment by military surgeons. Mil Med. 2004;169:265–269.PubMed

24.

Hawley JS, Murray CK, Griffith ME, McElmeel ML, Fulcher LC, Hospenthal DR, Jorgensen JH. Susceptibility of acinetobacter strains isolated from deployed U.S. military personnel. Antimicrob Agents Chemother. 2007;51:376–378.PubMedCrossRef

25.

Ibrahim EH, Sherman G, Ward S, Fraser VJ, Kollef MH. The influence of inadequate antimicrobial treatment of bloodstream infections on patient outcomes in the ICU setting. Chest. 2000;118:146–155.PubMedCrossRef

26.

Johnson EN, Burns TC, Hayda RA, Hospenthal DR, Murray CK. Infectious complications of open type III tibial fractures among combat casualties. Clin Infect Dis. 2007;45:409–415.PubMedCrossRef

27.

Kanafani ZA, Kara L, Hayek S, Kanj SS. Ventilator-associated pneumonia at a tertiary-care center in a developing country: incidence, microbiology, and susceptibility patterns of isolated microorganisms. Infect Control Hosp Epidemiol. 2003;24:864–869.PubMedCrossRef

28.

Kiehn CL. Progress attained in the search for the primary healing of gunshot wounds of the extremities in the ETO in World War II. Bull N Y Acad Med. 1989;65:866–878.PubMed

29.

Klein RS, Berger SA, Yekutiel P. Wound infection during the Yom Kippur war: observations concerning antibiotic prophylaxis and therapy. Ann Surg. 1975;182:15–21.PubMedCrossRef

30.

Kovaric JJ, Matsumoto T, Dobek AS, Hamit HF. Bacterial flora of one hundred and twelve combat wounds. Mil Med. 1968;133:622–624.PubMed

31.

Levin AS, Barone AA, Penco J, Santos MV, Marinho IS, Arruda EA, Manrique EI, Costa SF. Intravenous colistin as therapy for nosocomial infections caused by multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii. Clin Infect Dis. 1999;28:1008–1011.PubMedCrossRef

32.

Levin AS, Mendes CM, Sinto SI, Sader HS, Scarpitta CR, Rodrigues E, Sauaia N, Boulos M. An outbreak of multiresistant Acinetobacter baumanii in a university hospital in Sao Paulo, Brazil. Infect Control Hosp Epidemiol. 1996;17:366–368.PubMedCrossRef

33.

Linden PK, Kusne S, Coley K, Fontes P, Kramer DJ, Paterson D. Use of parenteral colistin for the treatment of serious infection due to antimicrobial-resistant Pseudomonas aeruginosa. Clin Infect Dis. 2003;37:e154–160.PubMedCrossRef

34.

Lortholary O, Fagon JY, Buu Hoi A, Mahieu G, Gutmann L. Colonization by Acinetobacter baumanii in intensive-care-unit patients. Infect Control Hosp Epidemiol. 1998;19:188–190.PubMedCrossRef

35.

Luna CM, Vujacich P, Niederman MS, Vay C, Gherardi C, Matera J, Jolly EC. Impact of BAL data on the therapy and outcome of ventilator-associated pneumonia. Chest. 1997;111:676–685.PubMedCrossRef

36.

Markou N, Apostolakos H, Koumoudiou C, Athanasiou M, Koutsoukou A, Alamanos I, Gregorakos L. Intravenous colistin in the treatment of sepsis from multiresistant Gram-negative bacilli in critically ill patients. Crit Care. 2003;7:R78–83.PubMedCrossRef

37.

Mazurek MT, Ficke JR. The scope of wounds encountered in casualties from the global war on terrorism: from the battlefield to the tertiary treatment facility. J Am Acad Orthop Surg. 2006;14(10 Suppl):S18–23.PubMed

38.

McKissock W, Wright J, Miles AA. The reduction of hospital infection of wounds. A controlled experiment. Br Med J. 1941;2:375–377.

39.

Michalopoulos AS, Tsiodras S, Rellos K, Mentzelopoulos S, Falagas ME. Colistin treatment in patients with ICU-acquired infections caused by multiresistant Gram-negative bacteria: the renaissance of an old antibiotic. Clin Microbiol Infect. 2005;11:115–121.PubMedCrossRef

40.

Miles AA, Schwabacher H, Cunliffe AC. Hospital infection of war wounds. Br Med J. 1940;2:855–859, 895–900.

41.

Murray CK, Hospenthal DR. Treatment of multidrug resistant Acinetobacter. Curr Opin Infect Dis. 2005;18:502–506.PubMedCrossRef

42.

Murray CK, Roop SA, Hospenthal DR, Dooley DP, Wenner K, Hammock J, Taufen N, Gourdine E. Bacteriology of war wounds at the time of injury. Mil Med. 2006;171:826–829.PubMed

43.

Oncul O, Keskin O, Acar HV, Kucukardali Y, Evrenkaya R, Atasoyu EM, Top C, Nalbant S, Ozkan S, Emekdas G, Cavuslu S, Us MH, Pahsa A, Gokben M. Hospital-acquired infections following the 1999 Marmara earthquake. J Hosp Infect. 2002;51:47–51.PubMedCrossRef

44.

Paolino K, Erwin D, Padharia V, Carrero H, Giron L, Burgess R, Burger C, Martinez M, Arrieta P, Wortmann G, Zapor M. In vitro activity of colistin against multidrug-resistant gram-negative bacteria isolated at a major army hospital during the military campaigns in Iraq and Afghanistan. Clin Infect Dis. 2007;45:140–141.PubMedCrossRef

45.

Pollak AN, Calhoun JH. Introduction. J Am Acad Orthop Surg. 2006;14(10 Suppl):viii–ix.PubMed

46.

Rotimi VO, al-Sweih NA, Feteih J. The prevalence and antibiotic susceptibility pattern of gram-negative bacterial isolates in two ICUs in Saudi Arabia and Kuwait. Diagn Microbiol Infect Dis. 1998;30:53–59.PubMedCrossRef

47.

Sauermann R, Rothenburger M, Graninger W, Joukhadar C. Daptomycin: A Review 4 Years after First Approval. Pharmacology. 2007;81:79–91.PubMedCrossRef

48.

Schaad HJ, Bento M, Lew DP, Vaudaux P. Evaluation of high-dose daptomycin for therapy of experimental Staphylococcus aureus foreign body infection. BMC Infect Dis. 2006;6:74.PubMedCrossRef

49.

Scott P, Deye G, Srinivasan A, Murray C, Moran K, Hulten E, Fishbain J, Craft D, Riddell S, Lindler L, Mancuso J, Milstrey E, Bautista CT, Patel J, Ewell A, Hamilton T, Gaddy C, Tenney M, Christopher G, Petersen K, Endy T, Petruccelli B. An outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus complex infection in the US military health care system associated with military operations in Iraq. Clin Infect Dis. 2007;44:1577–1584.PubMedCrossRef

50.

Smallman-Raynor MR, Cliff AD. Impact of infectious diseases on war. Infect Dis Clin North Am. 2004;18:341–368.PubMedCrossRef

51.

Trampuz A, Murphy CK, Rothstein DM, Widmer AF, Landmann R, Zimmerli W. Efficacy of a novel rifamycin derivative, ABI-0043, against Staphylococcus aureus in an experimental model of foreign-body infection. Antimicrob Agents Chemother. 2007;51:2540–2545.PubMedCrossRef

52.

U.S. casualty status. U.S. Department of Defense Web site. Available at: http://www.defenselink.mil/news/casualty.pdf. Accessed 26 Nov 2007.

53.

Valles J, Rello J, Ochagavia A, Garnacho J, Alcala MA. Community-acquired bloodstream infection in critically ill adult patients: impact of shock and inappropriate antibiotic therapy on survival. Chest. 2003;123:1615–1624.PubMedCrossRef

54.

Vara Prasad J. New oxazolidinones. Curr Opin Microbiol. 2007 Oct;10:454–460.PubMedCrossRef

55.

Velmahos GC, Jindal A, Chan L, Kritikos E, Vassiliu P, Berne TV, Demetriades D. Prophylactic antibiotics after severe trauma: more is not better. Int Surg. 2001;86:176–183.PubMed

56.

Velmahos GC, Toutouzas KG, Sarkisyan G, Chan LS, Jindal A, Karaiskakis M, Katkhouda N, Berne TV, Demetriades D. Severe trauma is not an excuse for prolonged antibiotic prophylaxis. Arch Surg. 2002;137:537–541; discussion 541–532.PubMedCrossRef

57.

Walters TJ, Mabry RL. Issues related to the use of tourniquets on the battlefield. Mil Med. 2005;170:770–775.PubMed

58.

Wannamaker GT, Pulaski EJ. Pyogenic neurosurgical infections in Korean battle casualties. J Neurosurg. 1958;15:512–518.PubMedCrossRef

59.

Wedmore I, McManus JG, Pusateri AE, Holcomb JB. A special report on the chitosan-based hemostatic dressing: experience in current combat operations. J Trauma. 2006;60:655–658.PubMed

60.

Whitman TJ. Infection control challenges related to war wound infections in the ICU setting. J Trauma. 2007;62(6 Suppl):S53.PubMed

61.

Yarboro SR, Baum EJ, Dahners LE. Locally administered antibiotics for prophylaxis against surgical wound infection. An in vivo study. J Bone Joint Surg Am. 2007;89:929–933.PubMedCrossRef

62.

Yin LY, Lazzarini L, Li F, Stevens CM, Calhoun JH. Comparative evaluation of tigecycline and vancomycin, with and without rifampicin, in the treatment of methicillin-resistant Staphylococcus aureus experimental osteomyelitis in a rabbit model. J Antimicrob Chemother. 2005;55:995–1002.PubMedCrossRef

63.

Yun HC, Murray CK, Roop SA, Hospenthal DR, Gourdine E, Dooley DP. Bacteria recovered from patients admitted to a deployed U.S. military hospital in Baghdad, Iraq. Mil Med. 2006;171:821–825.PubMed

64.

Ziglam H. Daptomycin and tigecycline: a review of clinical efficacy in the antimicrobial era. Expert Opin Pharmacother. 2007;8:2279–2292.PubMedCrossRef

Title: Multidrug-resistant Organisms in Military Wounds from Iraq and Afghanistan
Authors: Jason H. Calhoun, MD, FACS
Clinton K. Murray, MD, FIDSA, Maj.
M. M. Manring, PhD
Publication date: 01-06-2008
Publisher: Springer-Verlag
Published in: Clinical Orthopaedics and Related Research® / Issue 6/2008
Print ISSN: 0009-921X
Electronic ISSN: 1528-1132
DOI: https://doi.org/10.1007/s11999-008-0212-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Multidrug-resistant Organisms in Military Wounds from Iraq and Afghanistan

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 6/2008

Papers Presented at the 2007 Meeting of the Musculoskeletal Infection Society: Editorial Comment

Case Report

Staphylococcus aureus Nasal Decolonization in Joint Replacement Surgery Reduces Infection

Increased Oxacillin Resistance in Thigh Pyomyositis in Diabetic Patients

Correction of Forearm Malunion Guided by the Preoperative Complaint

Complications and Risk Factors for Failure of Rotationplasty: Review of 25 Patients