Multidrug-Resistant Acinetobacter Extremity Infections in Soldiers

Kepler A. Davis; Kimberly A. Moran; C. Kenneth McAllister; Paula J. Gray

Disclosures

Emerging Infectious Diseases. 2005;11(8) 

In This Article

Abstract and Introduction

Abstract

War wound infection and osteomyelitis caused by multidrug-resistant (MDR) Acinetobacter species have been prevalent during the 2003-2005 military operations in Iraq. Twenty-three soldiers wounded in Iraq and subsequently admitted to our facility from March 2003 to May 2004 had wound cultures positive for Acinetobacter calcoaceticus-baumannii complex. Eighteen had osteomyelitis, 2 burn infection, and 3 deep wound infection. Primary therapy for these infections was directed antimicrobial agents for an average of 6 weeks. All soldiers initially improved, regardless of the specific type of therapy. Patients were followed up to 23 months after completing therapy, and none had recurrent infection with Acinetobacter species. Despite the drug resistance that infecting organisms demonstrated in this series, a regimen of carefully selected extended antimicrobial-drug therapy appears effective for osteomyelitis caused by MDR Acinetobacter spp.

Introduction

Casualty statistics from the 2003-2005 military operations in Iraq show an increase in the ratio of wounded to fatal casualties compared to previous operations in the Persian Gulf, Vietnam, and Korea.[1] This relative increase of wounded casualties has led to an increased incidence of war wound infection and osteomyelitis, especially caused by multidrug-resistant (MDR) Acinetobacter species. The incidence of bacteremia at military medical facilities caused by Acinetobacter baumannii has also increased.[2] The current incidence of infection with Acinetobacter should not be surprising. These organisms were the most frequently recovered gram-negative isolate from war wounds and the second most frequent bacterium causing bloodstream infection in US Marines with extremity wounds during the Vietnam War.[3] In nonconflict environments, Acinetobacter species are rarely responsible for community-acquired infections. In the hospital setting, Acinetobacter species are an important cause of nosocomial infection, yet these infections were rarely encountered in our facility until we began observing them in soldiers with infected wounds. Nosocomial infections caused by Acinetobacter species include pneumonia, meningitis, bloodstream, urinary tract, surgical wound, and soft tissue infections.[4] Such infections are challenging to treat because of extensive antimicrobial drug resistance. Osteomyelitis caused by Acinetobacter occurs, but it is less frequently reported and had not been identified in our facility during the 14 months before March 2003. Optimal therapy for osteomyelitis caused by these organisms is not well defined because of limited available data. This case series reviews 1 military medical center's experience with these infections, including species identified, antimicrobial drug-susceptibility patterns, antimicrobial drug therapy, and clinical outcomes.

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