Practical approach to combat-related infections and antibiotics

Soon after military casualties from the wars in Iraq and Afghanistan began filtering back into medical centers throughout the USA, reports started to spread of a bacterial "superbug" that wounded soldiers were carrying back with them from the front lines. A series of unusual infections with resistant (though still carbapenem susceptible) Acinetobacter spp. surfaced on a Navy hospital ship, the US Comfort, in 2003. This was followed by outbreaks at military medical facilities in the USA, the level IV evacuation hospital in Landstuhl, Germany, and many civilian hospitals that accepted wounded veterans. Even more concerning, many of these outbreaks were now found to be caused by highly resistant Acinetobacter spp., no longer susceptible even to carbapenems or aminoglycosides. Rumors circulated that this bug was endemic in the soil and water of Iraq and was being blown into the wounds by improvised explosive devices. The truth was much simpler: they were catching this "superbug" at our forward military surgical hospitals, like the Ibn Sina facility in Baghdad. The lesson learned here is that even in a "mature" theater of combat operations, the combination of severe wounds with infected and dead tissue, less than ideal sterility conditions, and uncontrolled use of antibiotics is a recipe for infectious disease problems. Some of these factors are beyond control, but many of them are modifiable behavioral and practice patterns that you and your colleagues can adapt to minimize the chances of your patients experiencing a major infectious complication.