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Author(s): Jason H. Calhoun, M.D., F.A.C.S.*, MAJ. Clinton K. Murray; Columbia, MO

Title: Multi-drug resistant organisms in the War on Terror

Purpose: Infection from multi-drug resistant organisms (MDROs) is an increasing source of concern in wounded soldiers returning from Iraq and Afghanistan. More information is needed regarding the pathogens in order to guide future treatment.

Methods: A multidisciplinary team of orthopaedic surgeons (both military and civilian) and infectious disease specialists has embarked on a multi-year study of infections in extremity wounds. A survey was developed to review patient data from Brooke Army Medical Center (BAMC) in Texas and Walter Reed Army Medical Center (WRAMC) in Washington, D.C., the two major U.S. Army hospitals. Data from other military hospital facilities will be added as the project expands. The data under review include type of wound, cultures, sensitivity tests, sedimentation rates, and other clinical and demographic data. Key MDROs of concern, based on previous reports from military surgeons and anecdotal evidence, were Staphylococcus aureus, Acinetobacter baumannii, Klebsiella pneumonaie, and Pseudomonas aeruginosa.

Results: In a preliminary study, 223 cases of personnel wounded in Iraq and Afghanistan and evacuated to Brooke Army Medical Center (Fort Sam Houston, Texas) were evaluated from January to June 2006. Sixty-six (30percent) were evaluated for orthopaedic trauma. Twenty-six (40 percent) received antibiotics. The infectious agent in six cases were methicillin-resistant Staphylococcus aureus. There were sixteen cases of Acinetobacter baumannii, nine cases of Klebsiella pneumoniae, and six cases of Pseudomonas aeruginosa. The majority of isolates were multidrug resistant in nature requiring therapy with agents such as vancomycin, imipenemcilastatin and colistin.

Discussion: Preliminary results confirm that Klebsiella, Pseudomonas, and MRSA are serious sources of concern in military extremity wounds, and Acinetobacter is a source of concern in immunocompromised or otherwise unhealthy patients. The study will continue toward its goal of building a larger, multicenter database, containing information regarding thousands of military infections, with the ultimate objective of developing detailed recommendations regarding the use, timing, and dosage of antibiotics in military extremity infections. Table/Figure(s) None

Musculoskeletal Infecton Society
Musculoskeletal Infecton Society