Infectious Complications After Battlefield Injuries: Epidemiology, Prevention, and Treatment

Purpose of Review: Recent conflicts have resulted in an unprecedented proportion of survivors of complex battlefield injuries. These patients are predisposed to infectious complications with multidrug-resistant organisms (MDROs). The epidemiology, prevention, and treatment of these infections are described, with emphasis on recent literature. Recent Findings: Data from the Trauma Infectious Disease Outcomes Study (TIDOS) cohort have revealed a 27% rate of infectious complications in those evacuated after traumatic injury; this increases to 50% in the intensive care unit. Acinetobacter baumannii-calcoaceticus was common in casualties injured in Iraq, but was replaced by other extended-spectrum beta-lactamase-producing Enterobacteriaceae as well as fungi in casualties from Afghanistan. Prevention of infections includes short courses of narrow-spectrum prophylactic antimicrobials and infection control; the mainstay of wound infection prevention is debridement and irrigation. Treatment of many infections is primarily surgical and antimicrobial therapy directed against expected and recovered pathogens. Summary: Infections after combat trauma are common and complex, requiring a multidisciplinary approach to prevention and care.