698. Infectious Complications following Traumatic Injury among U.S. Military Personnel in Iraq and Afghanistan
Session: Poster Abstract Session: Skin, Soft Tissue and Joint Infections
Friday, October 21, 2011
Room: Poster Hall B1
Background: Combat-related infections are dependent upon multiple factors including mechanisms and environment of injury combined with hospital-associated risk. The Trauma Infectious Disease Outcome Study (TIDOS) began in June 2009 to prospectively collect data on infection burden along with prevention and treatment-specific outcomes.

Methods: The TIDOS project is a multisite prospective cohort with 5-yr follow-up including both DoD and VA data. An infectious diseases (ID) module augments the trauma registry data. Prospectively-defined criteria determine infection events.

Results: From Jun-Nov 2009, 704 patients were admitted to Landstuhl Regional Medical Center (LRMC) in Germany following traumatic injury (478 Afghanistan, 154 Iraq, 50 other sites) with 360 (51%) further transferred to a participating US hospital. Patients experiencing ≥ 1 incident infection increased from 4.8% at LRMC to 30.3% during US hospitalization. Overall infection incidence density rate was 2.2 per 100 person-days (interquartile range 2.0, 2.5). A total of 127 patients experienced ≥ 1 infection (295 unique infection events) and the most common syndromes observed were soft tissue wound infections (34%), bloodstream infections (20%), pneumonia (12%), and osteomyelitis (11%). Factors associated with increased infection rates included explosive blast injury (p<0.0001), Afghanistan deployment (p=0.0006), injury severity score ≥ 15 (p<0.0001), extremity amputation (p<0.0001), and massive (≥ 10 units) blood transfusion 1st 24 h post-injury (<0.0001).

Conclusion: Infectious complications are common following combat-related trauma increasing as wounded patients move to higher levels of extended care. Infection risk varies based on factors related to injury. These data will provide unique insights into short and long term infectious complications of combat trauma applicable to prevention and treatment strategies.


Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

David Tribble, MD, DrPH1, Clinton K. Murray, MD2, Amy Weintrob, MD3, Tyler Warkentien, MD4, Anuradha Ganesan, MD1,5, Lakisha Gaskins, MHS6, Ping Li, MS1, Susan Fraser, MD7, Eugene Millar, PhD3, Michael Landrum, MD2,3, Duane Hospenthal, MD, PhD8, William P. Bradley, MS3, Francoise Seillier-Moiseiwitsch, PhD1, James Dunne, MD9, Glenn Wortmann, MD10, Jay McDonald, MD11,12 and Bradley Lloyd, MD13, (1)IDCRP/Uniformed Services Univ. of the Hlth. Sci., Bethesda, MD, (2)San Antonio Military Medical Center, Fort Sam Houston, TX, (3)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, (4)Infectious Disease, National Naval Medical Center, Bethesda, MD, (5)Infectious Disease Clinic, National Naval Medical Center, Bethesda, MD, (6)IDCRP/Uniformed Services Univ Health Sci, Bethesda, MD, (7)Walter Reed Army Medical Center, Washington , DC, (8)San Antonio Military Medical Center, MCHE MDI 7 East, TX, (9)National Naval Medical Center, Bethesda, MD, (10)Uniformed Services University, Bethesda, MD, (11)Washington University School of Medicine, St. Louis, MO, (12)St. Louis Veterans Affairs Medical Center, St. Louis, MO, (13)Landstuhl Regional Medical Center, Landstuhl, Germany

Disclosures:

D. Tribble, None

C. K. Murray, None

A. Weintrob, None

T. Warkentien, None

A. Ganesan, None

L. Gaskins, None

P. Li, None

S. Fraser, None

E. Millar, None

M. Landrum, None

D. Hospenthal, None

W. P. Bradley, None

F. Seillier-Moiseiwitsch, None

J. Dunne, None

G. Wortmann, None

J. McDonald, None

B. Lloyd, 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.