Wounded Soldiers contract rare blood infection

Doctors at Walter Reed, Landstuhl medical centers work to stem antibiotic-resistant
bacteria

by Chris Walz

An unexpectedly high number of Soldiers injured in Iraq and Afghanistan are testing
positive for a rare, antibiotic-resistant blood infection, Army officials said
Friday. A total of 102 Soldiers tested positive for the bacteria Acinetobacter
baumannii between Jan. 1, 2002 and Aug. 31, 2004.

Doctors at Walter Reed Army Medical Center and Landstuhl Regional Medical Center,
in Germany, are unsure where the Soldiers contracted the blood infections —
whether it was on the battlefield, at a field station or a military hospital,
like Walter Reed or Landstuhl. Lt. Col. Joel Fishbain, assistant chief of Infectious
Diseases at Walter Reed, said he believes the infections stem from the initial
treatment of a wound on the frontlines because the bacteria can be found scarcely
in soil and water.

"The medics on the frontlines do the best job in the world, they’re the best hands down, but it’s not the most sterile environment," Fishbain said. "You can’t just take hospital practices and throw it out in the field."

The bacterium does not spread like a flesh-eating virus and is not overly dangerous in the civilized world, according to Fishbain, although it may require a higher level of amputation if it’s allowed to brew. He said the infection is found more frequently in underdeveloped countries along South America’s eastern seaboard and Brazil, and it can be fatal in those countries.

The paramount problem for doctors here is the bacteria’s resistance to antibiotics. Typical drugs, like Amoxicillin and Cipro — which became a household name following the Anthrax attacks in 2001 — have little effect on the bacteria. Sometimes, the only drug to fight the infection is an older drug called colistin, but doctors are cautious because it has a high toxicity level.

"This is a highly resistant organism, it’s only sensitive to one or two antibiotics," Fishbain said. "It’s a little scary because pharmaceutical companies are working so hard to develop HIV and fungus drugs, and they’re neglecting these types of antibiotics. Bacteria and viruses are becoming more and more resistant every day. It takes years to develop these types of antibiotics, so they’re not going to pop up overnight. We have to be careful how we use these antibiotics. If we use these antibiotics injudiciously now, they won’t work in the future."

The Centers for Disease Control and Prevention also pointed out the need to develop new antimicrobial drugs to treat highly resistant infections.

In August, Michael Dukes wrote in the Walter Reed Stripe that doctors were already battling the bacteria. He reported 222 service members — not just Soldiers — have contracted the bacteria since March 2003. An updated figure was not available at press time.

"This is the bug that is colonizing [in] many of our injured Soldiers coming back from Iraq," Walter Reed’s Infection Control head nurse Fluryanne Leach told Dukes. "It’s not a particularly nasty organism normally, but it’s opportunistic. When it causes infections, it’s in people who are debilitated in some way. In the U.S., we normally see it in trauma patients. Until the war in Iraq, it was never a problem here at [Walter Reed] or at other Army medical center either. Almost from the beginning of the war in Iraq, we were finding our traumatically-injured Soldiers were coming back either with colonization or infection."

The reported 102 Army infections are considerably higher than the typical one or two infections occurring annually at each military hospital. The chances of infection, however, are still slim for those who are in theater or have spent time there, according to the Centers for Disease Control and Prevention. Since the Iraq injuries topped 9,300 this week, the chance of contracting the infection is less than one percent.

It is possible to spread the bacteria in a sterile hospital. The spread is dramatically reduced when health-care workers wash their hands and use alcohol swabs, according to the Centers for Disease Control and Prevention.

Walter Reed and Landstuhl treated a huge majority of infections. Walter Reed found 45 patients with the infection, but 16 of them were not fighting in Iraq of Afghanistan. At Landstuhl, 33 patients presented the bacteria and only one of those patients was not in the war.

Infections have also shown up at Bethesda National Naval Medical Center, Brooke Army Medical Center in Texas and the Navy’s USS Comfort. The Army initiated laboratory surveillance at all of the military medical centers and at each forward deployed combat support hospital.

The Army Surgeon General’s office has tasked a multi-service epidemiological consultation team to investigate the infections and to recommend preventative measures.

There are reports the bacteria was also found in Soldiers injured in Vietnam and, more recently, in victims of the Turkish earthquake.

http://www.dcmilitary.com/army/pentagram/9_48/features/32253-1.html