573. Epidemiology of Bacterial Infections at a US Theater Hospital in Afghanistan
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: Wartime operations in Afghanistan have intensified with increased casualties in both US service-members and the local population. Bacterial epidemiology from US hospitals in Iraq has been well described, but such investigations from Afghanistan have not been reported. We sought to describe the clinical and microbiological epidemiology of bacterial infections in patients at the largest US theater hospital in Afghanistan.
Methods: All bacterial cultures from Sept 2007 - Aug 2008 were reviewed. Data including demographics, diagnoses, and dates of admission were obtained by record review. Bacterial species were identified and antibiotic susceptibility determined using CLSI criteria. Statistical analysis including Chi-squared or Fisher’s exact text was performed with SPSS software.
Results: Two hundred sixty-six patients had one or more positive cultures, with a total of 411 isolates. The most common bacteria included E coli (25%), S aureus (21%), and A baumanii (13%). Eighty-one percent of cultures were from local national patients. Fifty-nine percent of cultures were from trauma patients. Among E coli, P mirabilis, and Klebsiella spp, forty-two percent of all and 35% of community-acquired cultures were extended spectrum beta-lactamase (ESBL) producers. Among all gram-negative cultures, 69% of all and 44% of community-acquired isolates were multi-drug resistant (MDR). Risk factors for ESBL or MDR-gram negatives included history of trauma, prolonged hospitalization, age <18 years, and Afghan nationality.
Conclusions: Most bacterial infections CJTH were from local national patients, with extremely high rates of resistant gram-negatives. These data support previous investigations in Iraq which suggest that intrinsic gram negative resistance in the local population may contribute to colonization and subsequent infection in returning US service-members.
Linda Bradshaw, MD1, Robert Elwood, MD2, Clinton K. Murray, MD3, Lucas Simkins, MD4, Amy Summers, MD5, Deena Sutter, MD6, Glenn Wortmann, MD5 and  D. Sutter, None..
A. Summers, None..
L. Bradshaw, None..
R. L. Elwood, None..
L. H. Simkins, None..
G. Wortmann, None..
C. Murray, None., (1)Wilford Hall Medical Center, Lackland AFB, TX, (2)Lackland Air Force Base, (3)Brooke Army Medical Center, Ft. Sam Houston, TX, (4)Tinker AFB, TinkerAFB, OK, (5)Walter Reed Army Medical Center, Washington, DC, (6)Wilford Hall Ambulatory Surgical Center, Lackland AFB, TX

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