Microbiology of combat-related extremity wounds: Trauma Infectious Disease Outcomes Study

Katrin Mende; Laveta Stewart; Faraz Shaikh; William Bradley; Dan Lu; Margot R Krauss; Lauren Greenberg; Qilu Yu; Dana M Blyth; Timothy J Whitman; Joseph L Petfield; David R Tribble

doi:10.1016/j.diagmicrobio.2018.12.008

Microbiology of combat-related extremity wounds: Trauma Infectious Disease Outcomes Study

Diagn Microbiol Infect Dis. 2019 Jun;94(2):173-179. doi: 10.1016/j.diagmicrobio.2018.12.008. Epub 2018 Dec 29.

Authors

Affiliations

¹ Infectious Disease Clinical Research Program, Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Dr, Bethesda, MD, 20817, USA; Brooke Army Medical Center, 3551 Roger Brooke Dr, MCHE-MDI, JBSA Fort Sam Houston, TX 78234, USA. Electronic address: katrin.mende.ctr@mail.mil.
² Infectious Disease Clinical Research Program, Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Dr, Bethesda, MD, 20817, USA.
³ Infectious Disease Clinical Research Program, Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Dr, Bethesda, MD, 20817, USA; Brooke Army Medical Center, 3551 Roger Brooke Dr, MCHE-MDI, JBSA Fort Sam Houston, TX 78234, USA.
⁴ Westat, 1600 Research Blvd, Rockville, MD, 20850, USA.
⁵ Brooke Army Medical Center, 3551 Roger Brooke Dr, MCHE-MDI, JBSA Fort Sam Houston, TX 78234, USA.
⁶ Walter Reed National Military Medical Center, 8901 Rockville Pike, Bethesda, MD, 20889, USA.
⁷ Landstuhl Regional Medical Center, Landstuhl, Germany, CMR 402, APO, AE, 09180.
⁸ Infectious Disease Clinical Research Program, Preventive Medicine & Biostatistics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, USA.

Abstract

We present extremity wound microbiology data from 250 combat casualties (2009-2012). Confirmed extremity wound infections (EWIs) were based on clinical and laboratory findings. Suspected EWIs had isolation of organisms from wound cultures with associated signs/symptoms not meeting clinical diagnostic criteria. Colonized wounds had organisms isolated without any infection suspicion. A total of 335 confirmed EWIs (131 monomicrobial and 204 polymicrobial) were assessed. Gram-negative bacteria were predominant (57% and 86% of monomicrobial and polymicrobial infections, respectively). In polymicrobial infections, 61% grew only bacteria, while 30% isolated bacteria and mold. Multidrug resistance was observed in 32% of isolates from first monomicrobial EWIs ±3 days of diagnosis, while it was 44% of isolates from polymicrobial EWIs. Approximately 96% and 52% of the suspected and colonized wounds, respectively, shared ≥1 organism in common with the confirmed EWI on the same patient. Understanding of combat-related EWIs can lead to improvements in combat casualty care.

Keywords: Extremity infections; Extremity wounds; Open fractures; Trauma-related infections; Wound microbiology.

MeSH terms

Anti-Infective Agents / therapeutic use
Bacteria / classification
Bacteria / isolation & purification*
Bacterial Infections / epidemiology
Bacterial Infections / microbiology*
Coinfection / epidemiology
Coinfection / microbiology
Drug Resistance, Microbial
Fungi / classification
Fungi / isolation & purification*
Humans
Military Personnel*
Mycoses / epidemiology
Mycoses / microbiology*
Treatment Outcome
United States / epidemiology
Wound Infection / epidemiology
Wound Infection / microbiology*

Substances

Anti-Infective Agents

Abstract

MeSH terms

Substances

Grants and funding