549. Microbiological Agents Associated With Death in Wounded Service Members During Operations Iraqi And Enduring Freedom
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: In the majority of fatal battle-related injuries in the Global War on Terrorism (GWOT), death occurs soon after the injuries are sustained, within minutes to days, from mechanisms directly related to trauma. In cases that are not rapidly lethal, stabilization, evacuation, and treatment allow for extended definitive care which mitigates against death from the direct sequelae of combat wounds, but affords opportunity for death due to less direct agents such as wound infections. We report the role of trauma-related infectious GWOT deaths.
Methods: The Mortality Surveillance Division of the Armed Forces Medical Examiner System tracks the cause of death in all U.S. active duty military personnel, including trauma-related deaths. Data are captured from autopsy reports, and other available related records, including peri-mortem cultures. These documents are used to determine if an infectious agent was a contributing cause of death.
Results: From 2001 to 2008, there were a total of 3,754 combat-related deaths. Of those, 129 (3.3%) died of wounds after evacuation from a combat theater. In 4 deaths, a post-mortem examination was not conducted. In the remaining 125 cases, an infection was reported in 60 (48%) individuals. In 55 of these cases, the death was partially attributable to an infectious process (e.g., sepsis, pneumonia, wound infection). Peri-mortem cultures (121 total) in these 60 deaths identified Klebsiella (22%), Acinetobacter (19%) and Pseudomonas (17%) as the most common pathogens.
Conclusion: Fatal injuries sustained in combat are typically devastating and if survivable initially require prolonged hospitalization. Individuals who survive the immediate direct effects of these injuries are susceptible to bacterial infections related to these injuries, most typically from gram-negative organisms.
Joel Gaydos, MD1, Joyce Lapa, MD2, Craig Mallak, MD3, Robert Potter, DVM3 and  R. N. Potter, None..
J. A. Lapa, None..
C. T. Mallak, None..
J. C. Gaydos, None., (1)Armed Forces Health Surveillance Center, Silver Spring, MD, (2)NMRC, (3)Armed Forces Medical Examiner's Office, Rockville, MD