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16 : Multidrug-Resistant Acinetobacter Infections in U.S. Military Personnel, 2003 to 2005
This chapter discusses the military's clinical experience with severe infection caused by multidrug-resistant (MDR) Acinetobacter spp. in wounded personnel. Acinetobacter is primarily associated with nosocomial infections, accounting for 1% of nosocomial bloodstream infections (BSIs) and 3% of nosocomial pneumonias in U.S. hospitals, according to the Centers for Disease Control and Prevention National Nosocomial Infection Surveillance report. The majority of infections have involved wounds and osteomyelitis. There have also been a number of cases of bacteremia and a few isolated cases of pneumonia, empyema, peritonitis, urinary tract infections, sinusitis, and meningitis. Treatment of Acinetobacter infections in personnel stationed in or returning from Southwest Asia has become a major challenge. The majority of isolates were resistant to ampicillin, cefepime, ceftazidime, cefotaxime, ciprofloxacin, levofloxacin, gentamicin, tobramycin, piperacillin, and trimethoprim-sulfamethoxazole. Our current recommendation for treatment of active-duty personnel with Acinetobacter infections is directed based on susceptibility testing. The outbreak of infections with MDR Acinetobacter in military personnel has resulted in the institution of new infection control standards in military medical centers caring for these casualties. Osteomyelitis caused by MDR Acinetobacter seems to initially respond to a multifaceted approach, including appropriate surgical debridement, carefully selected antimicrobial therapy based on susceptibility patterns, and careful follow-up.