16 : Multidrug-Resistant Infections in U.S. Military Personnel, 2003 to 2005

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Preview this chapter:
Zoom in

Multidrug-Resistant Infections in U.S. Military Personnel, 2003 to 2005, Page 1 of 2

| /docserver/preview/fulltext/10.1128/9781555815585/9781555813772_Chap16-1.gif /docserver/preview/fulltext/10.1128/9781555815585/9781555813772_Chap16-2.gif


This chapter discusses the military's clinical experience with severe infection caused by multidrug-resistant (MDR) spp. in wounded personnel. 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 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 infections is directed based on susceptibility testing. The outbreak of infections with MDR 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 seems to initially respond to a multifaceted approach, including appropriate surgical debridement, carefully selected antimicrobial therapy based on susceptibility patterns, and careful follow-up.

Citation: Davis K, Moran K. 2007. Multidrug-Resistant Infections in U.S. Military Personnel, 2003 to 2005, p 309-323. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch16
Highlighted Text: Show | Hide
Loading full text...

Full text loading...


1. A. Abbo,, S. Navon-Venezia,, O. Hammer-Muntz,, T. Krichali,, Y. Siegman-Igra, and, Y. Carmeli. 2005. Multidrug-resistant Acinetobacter baumannii. Emerg. Infect. Dis. 11: 2229.
2. Al-Khoja, M. S., and, J. H. Darrell. 1979. The skin as the source of Acinetobacter and Moraxella species occurring in blood cultures. J. Clin. Pathol. 32: 497499.
3. Andrews, H. J., 1986. Acinetobacter bacteriocin typing. J. Hosp. Infect. 7: 169175.
4. Anstey, N. M.,, B. J. Currie, and, K. M. Withnall. 1992. Community-acquired Acinetobacter pneumonia in the Northern Territory of Australia. Clin. Infect. Dis. 20: 790796.
5. Ayan, M.,, R. Durmaz,, E. Aktas, and, B. Durmaz. 2003. Bacteriological, clinical, and epidemiological characteristics of hospital acquired Acinetobacter baumannii infection in a teaching hospital. J. Hosp. Infect. 54: 3945.
6. Aygun, G.,, O. Demirkirian,, T. Utku,, B. Mete,, S. Urkmez,, M. Yilmaz,, H. Yasar,, Y. Dikmen, and, R. Ozturk. 2002. Environmental contamination during a carbapenem-resistant Acinetobacter baumannii outbreak in an intensive care unit. J. Hosp. Infect. 52: 259262.
7. Berezin, E. B., and, K. J. Towner. 1996. Acinetobacter spp. as nosocomial pathogens: microbiological, clinical, and epidemiological features. Clin. Microbiol. Rev. 9: 148165.
8. Bouvet, P. J., and, P. A. Grimont. 1987. Identification and biotyping of clinical isolates of Acinetobacter. Ann. Inst. Pasteur Microbiol. 138: 569578.
9. Catalano, M.,, L. S. Quelle,, P. E. Jeric,, A. DiMartino, and, S. M. Maimone. 1999. Survival of Acinetobacter baumannii on bed rails during an outbreak and during sporadic cases. J. Hosp. Infect. 42: 2735.
10. Centers for Disease Control and Prevention., 2004. Acinetobacter baumannii infections among patients at military medical facilities treating injured U.S. service members, 2002–2004. Morb. Mortal. Wkly. Rep. 53: 10631066.
11. Corbella, X.,, M. Pujol,, J. Ayats,, M. Sendra,, C. Ardanuy,, M. A. Dominguez,, J. Linares,, J. Ariza, and, F. Gudiol. 1996. Relevance of digestive tract colonization in the epidemiology of nosocomial infections due to multiresistant Acinetobacter baumannii. Clin. Infect. Dis. 23: 329334.
12. Davis, K. A.,, K. A. Moran,, C. K. McAllister, and, P. J. Gray. 2005. Multidrug-resistant Acinetobacter extremity infections in soldiers. Emerg. Infect. Dis. 11: 12181224.
13. Department of Defense, Directorate for Information Operations and Reports. 18 April 2005. Military casualty information. [Online.] http://siadapp.dior.whs.mil/personnel/CASUALTY/castop.htm.
14. Dijkshoorn, L., and, J. van der Toorn. 1992. Acinetobacter species: which do we mean? Clin. Infect. Dis. 15: 748749.
15. Gales, A. C.,, R. N. Jones,, K. R. Forward,, J. Linares,, H. S. Sader, and, J. Verhoef. 2001. Emerging importance of multidrug-resistant Acinetobacter species and Stenotrophomonas maltophilia as pathogens in seriously ill patients: geographic patterns, epidemiological features, and trends in the SENTRY Antimicrobial Surveillance Program (1997–1999). Clin. Infect. Dis. 32(Suppl. 2) : S104S113.
16. Garnacho-Montero, J.,, C. Ortiz-Leyba,, F. J. Jimenez-Jimenez,, A. E. Barrero-Almodovar,, J. L. Garcia-Garmendia,, M. Bernabeu-Wittell,, S. L. Gallego-Lara, and, J. I. Madrazo-Osuna. 2003. Treatment of multidrug-resistant Acinetobacter baumannii ventilator-associated pneumonia (VAP) with intravenous colistin: a comparison with imipenem-susceptible VAP. Clin. Infect. Dis. 36: 11111118. (First published 14 April 2003.)
17. Gerner-Smidt, P.,, I. Tjernberg, and, J. Ursing. 1991. Reliability of phenotypic tests for identification of Acinetobacter species. J. Clin. Microbiol. 29: 277282.
18. Glew, R. H.,, R. C. Moellering, Jr., and, L. J. Kunz. 1977. Infections with Acinetobacter calcoaceticus ( Herellea vaginicola): clinical laboratory studies. Medicine 56: 7997.
19. Go, E. S.,, C. Urban,, J. Burns,, B. Kreiswirth,, W. Eisner,, N. Mariano,, K. Mosinka-Snipas, and, J. J. Rahal. 1994. Clinical and molecular epidemiology of Acinetobacter infections sensitive only to polymyxin B and sulbactam. Lancet 344: 13291332.
20. Husni, R. N.,, L. S. Goldstein,, A. C. Arroliga,, G. S. Hall,, C. Fatica,, J. K. Stoller, and, S. M. Gordon. 1999. Risk factors for an outbreak of multi-drug-resistant Acinetobacter nosocomial pneumonia among intubated patients. Chest 115: 13781382.
21. Jain, R., and, L. H. Danziger. 2004. Multidrug-resistant Acinetobacter infections: an emerging challenge to clinicians. Ann. Pharmacother. 38: 14491459. (First published 27 July 2004.)
22. Kwa, A. L.,, C. Loh,, J. G. Low,, A. Kurup, and, V. H. Tam. 2005. Nebulized colistin in the treatment of pneumonia due to multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa. Clin. Infect. Dis. 41: 754757. (First published 20 July 2005.)
23. Landman, D.,, J. M. Quale,, D. Mayorga,, A. Adedeji,, K. Vangala,, J. Ravishankar,, C. Flores, and, S. Brooks. 2002. Citywide clonal outbreak of multiresistant Acinetobacter baumannii and Pseudomonas aeruginosa in Brooklyn, NY. The preantibiotic era has returned. Arch. Intern. Med. 162: 15151520.
24. Larson, E. L., 1981. Persistent carriage of gram-negative bacteria on hands. Am. J. Infect. Control. 9: 112119.
25. Lazzarini, L.,, J. T. Mader, and, J. H. Calhoun. 2004. Osteomyelitis in long bones. J. Bone Joint Surg. Am. 86: 23052318.
26. Lew, D. P., and, F. A. Waldvogel. 2004. Osteomyelitis. Lancet 364: 369379.
27. Lortholary, O.,, J. Y. Fagon,, A. B. Hoi,, M. A. Slama,, J. Pierre,, P. Giral,, R. Rosenzweig,, L. Gutmann,, M. Safar, and, J. Acar. 1995. Nosocomial acquisition of multi-resistant Acinetobacter baumannii: risk factors and prognosis. Clin. Infect. Dis. 20: 790796.
28. Manikal, V. M.,, D. Landman,, G. Saurina,, E. Oydna,, H. Lal, and, J. Quale. 2000. Endemic carbapenamresistant Acinetobacter species in Brooklyn, New York: citywide prevalence, interinstitutional spread, and relation to antibiotic usage. Clin. Infect. Dis. 31: 101106.
29. Marques, M. B.,, E. S. Brookings,, S. A. Moser,, P. B. Sonke, and, K. B. Waites. 1997. Comparative in vitro antimicrobial susceptibilities of nosocomial isolates of Acinetobacter baumannii and synergistic activities of nine antimicrobial combinations. Antimicrob. Agents Chemother. 41: 881885.
30. McDonald, L. C., 2001. Understanding and controlling the threat of multidrug-resistant Acinetobacter spp. Semin. Infect. Control 1: 191201.
31. National Nosocomial Infections Surveillance System. 1998. National Nosocomial Infections Surveillance System (NNIS) report, data summary from October 1986–April 1998, issued June 1998. Am. J. Infect. Control 26: 522533.
32. Rahal, J. J.,, C. Urban, and, S. Segal-Maurer. 2002. Nosocomial antibiotic resistance in multiple gram-negative species: experience at one hospital with squeezing the resistance balloon at multiple sites. Clin. Infect. Dis. 34: 499503.
33. Reina, R.,, E. Estenssoro,, G. Saenz,, H. S. Canales,, R. Gonzalvo,, G. Vidal,, G. Martins,, A. Das Neves,, O. Santander, and, C. Ramos. 2005. Safety and efficacy of colistin in Acinetobacter and Pseudomonas infections: a prospective cohort study. Intensive Care Med. 31: 10581065. (First published 28 June 2005.)
34. Scaife, W.,, H. K. Young,, R. H. Paton, and, S. G. Amyes. 1995. Transferable imipenem-resistance in Acinetobacter species from a clinical source. J. Antimicrob. Chemother. 36: 585586.
35. Tong, M. J., 1972. Septic complications of war wounds. JAMA 219: 10441047.
36. U.S. Army Center for Health Promotion and Preventive Medicine. 2005. Investigating Acinetobacter baumannii Infections at U.S. Army Military Treatment Facilities, 27 August 2004 to 27 May 2005. Epidemiological consultation no. 12-HA-01JK-04.
37. Urban, C.,, N. Mariano,, J. J. Rahal, et al. 2001. Polymyxin B-resistant Acinetobacter baumannii clinical isolates susceptible to recombinant BPI21 and cecropin P1. Antimicrob. Agents Chemother. 45: 994995.
38. Urban, C.,, S. Segal-Maurer, and, J. J. Rahal. 2003. Considerations in control and treatment of nosocomial infections due to multidrug-resistant Acinetobacter baumannii. Clin. Infect. Dis. 36: 12681274.
39. Van Looveren, M.,, H. Goossens, and the ARPAC Steering Group., 2004. Antimicrobial resistance of Acinetobacter spp. in Europe. Clin. Microbiol. Infect. 10: 684704.
40. Villegas, M. V., and, A. I. Hartstein. 2003. Acinetobacter outbreaks, 1977–2000. Infect. Control 24: 284295.
41. Visalli, M. A.,, M. R. Jacobs,, T. D. Moore,, F. A. Renzi, and, P. C. Appelbaum. 1997. Activities of βlactams against Acinetobacter genospecies as determined by agar dilution and E-test MIC methods. Antimicrob. Agents Chemother. 41: 767770.
42. Wagenvoort, J. H. T.,, E. I. G. B. DeBrauwer,, H. M. J. Toenbreker, and, C. J. van der Linden. 2002. Epidemic Acinetobacter baumannii strain with MRSA-like behaviour carried by healthcare staff. Eur. J. Clin. Microbiol. Infect. Dis. 21: 326327.
43. Wagenvoort, J. H. T., and, E. J. A. J. Joosten. 2002. An outbreak of Acinetobacter baumannii that mimics MRSA in its environmental longevity. J. Hosp. Infect. 52: 226227.
44. Waldvogel, F. A., and, H. Vasey. 1980. Osteomyelitis: the past decade. N. Engl. J. Med. 303: 360370.
45. Wendt, C.,, B. Dietze,, E. Dietz, and, H. Ruden. 1997. Survival of Acinetobacter baumannii on dry surfaces. J. Clin. Microbiol. 35: 13941397.


Generic image for table
Table 1.

genomic species

Citation: Davis K, Moran K. 2007. Multidrug-Resistant Infections in U.S. Military Personnel, 2003 to 2005, p 309-323. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch16
Generic image for table
Table 2.

Susceptibilities of 409 clinical isolates collected in 2003 and 2004 at WRAMC

Citation: Davis K, Moran K. 2007. Multidrug-Resistant Infections in U.S. Military Personnel, 2003 to 2005, p 309-323. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch16
Generic image for table
Table 3.

Antimicrobial prophylaxis of battlefield wounds

Citation: Davis K, Moran K. 2007. Multidrug-Resistant Infections in U.S. Military Personnel, 2003 to 2005, p 309-323. In Scheld W, Hooper D, Hughes J (ed), Emerging Infections 7. ASM Press, Washington, DC. doi: 10.1128/9781555815585.ch16

This is a required field
Please enter a valid email address
Please check the format of the address you have entered.
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error