974. Combat Casualties Evacuated from Iraq and Afghanistan who Develop Pneumonia
Session: Poster Abstract Session: Clinical Studies of Bacterial Infection
Saturday, October 22, 2011
Room: Poster Hall B1
Background: Infectious are a leading cause of morbidity and mortality associated with combat-related injuries from Iraq and Afghanistan. Although there is a growing body of literature looking at certain infectious complications, no study has looked at rates of pneumonia. Utilizing the VA/DoD  Trauma Infectious Disease Outcome Study (TIDOS), we assessed US casualties from Iraq and Afghanistan for the presence of pneumonia and associated pathogens.

Methods: We characterized the rates of pneumonia from June through November 2009 of patients admitted to the military treatment facility (MTF) in Germany and then evacuated further to one of the 3 participating US MTFs utilizing data collected in the Joint Theater Trauma Registry and TIDOS. We evaluated demographics, pneumonia rates for those admitted to the ICU and pathogens recovered on culture.  

Results: Of the 704 casualties admitted to Germany, 17 (2.4%) developed pneumonia with the rate increasing to 8.1% of the 211 ICU admissions. Among the 360 casualties that were evacuated to the 3 US MTFs, the overall pneumonia rate was 4.7% and of the 133 ICU admissions the rate was 9.8%. For the 32 patients developing pneumonia, 97% were male, and the median age was 26 years (IQR 22.4, 34.0). Thirteen had a penetrating thoracic or abdominal cavity injury and 21 had penetrating head injury or closed skull/facial bone fracture.  The median time to onset was 4.5 days (IQR 4.0, 6.0) with 94% of episodes mechanically ventilated within 48 hours prior to diagnosis. Of the 106 bacteria recovered, the most common were Pseudomonas aeruginosa (23), Serratia marcescens (14), Enterobacter aerogenes (11), Acinetobacter baumannii-calcoaceticus (10) and Staphylococcus aureus (10). Although there were 2 deaths, they were not attributed to pneumonia with 25% of episodes categorized as progression and not responsive to initial therapy.

Conclusion: Combat-related injuries suffer a relatively high rate of pneumonia especially in those requiring requiring mechanical ventilation following injury. Gram negative pathogens were the primary infection pathogens. Continued focus on pneumonia prevention strategies are necessary for casualties of war.


Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Clinton K. Murray, MD1, Nicholas Conger, MD2, Bradley Lloyd, MD3, Michael Landrum, MD1,4, Susan Fraser, MD5, Ping Li, MS6, Amy Weintrob, MD6, Anuradha Ganesan, MD6, Duane Hospenthal, MD, PhD7, Gaskins Kisha, MPH6, Eugene Millar, PhD6, Francoise Seillier-Moiseiwitsch, PhD6 and David Tribble, MD, DrPH6, (1)San Antonio Military Medical Center, Fort Sam Houston, TX, (2)Keesler Medical Center, Keesler Air Force Base, MS, (3)Landstuhl Regional Medical Center, Landstuhl, Germany, (4)IDCRP, Uniformed Services Univ. of the Health Sci., Ft. Sam Houston, TX, (5)Walter Reed Army Medical Center, Washington , DC, (6)IDCRP/Uniformed Services Univ. of the Hlth. Sci., Bethesda, MD, (7)San Antonio Military Medical Center, MCHE MDI 7 East, TX

Disclosures:

C. K. Murray, None

N. Conger, None

B. Lloyd, None

M. Landrum, None

S. Fraser, None

P. Li, None

A. Weintrob, None

A. Ganesan, None

D. Hospenthal, None

G. Kisha, None

E. Millar, None

F. Seillier-Moiseiwitsch, None

D. Tribble, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.