Epidemiology of infections associated with combat-related injuries in Iraq and Afghanistan

Enhanced medical training of front line medical personnel, personal protective equipment, and the presence of far forward surgical assets have improved the survival of casualties in the current wars in Iraq and Afghanistan. As such, casualties are at higher risk of infectious complications of their injuries including sepsis, which was a noted killer of casualties in previous wars. During the current conflicts, military personnel who develop combat-related injuries are at substantial risk of developing infections with multidrug resistant bacteria. Herein, we describe the bacteriology of combat-related injuries in Operation Iraqi Freedom and Operation Enduring Freedom that develop infections with particular attention to injuries of the extremities, central nervous system, abdomen and thorax, head and neck, and burns. In addition, the likely sources of combat-related injuries with multidrug resistant bacteria infections are explored.