Program Schedule

709
Clinical Epidemiology of Obligate Anaerobic Infections in Military Trauma Patients from Iraq and Afghanistan

Session: Poster Abstract Session: Approach to Clinical Infections
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • poster epidemiology IDSA submitted.pdf (83.0 kB)
  • Background:

    Combat-related injured patients have historically been noted to have decreasing rates of obligate anaerobic wound infections after the first week following injury, reaching nadir after day 20. This study defines the epidemiology, and outcomes of infection with obligate anaerobes among US military patients injured in Iraq and Afghanistan. 

    Methods: Utilizing the Trauma Infectious Disease Outcome Study (TIDOS) population between June 2009 and May 2013, all patients with obligate anaerobic bacteria were compiled.  Clinical information (demographics, injury data, outcomes) associated with obligate anaerobes was evaluated. 

    Results:

    69 patients with 84 unique isolates were evaluated.  51 (74%) injuries were due to explosive device blasts, 8 (12%) to gunshot wounds (GSW) and 87% of patients were initially hospitalized in Afghanistan, 96% required hospitalization in the ICU. The median time from injury to positive culture was13 days (IQR 7,27).The majority of the isolates (74%) were from wounds  and primarily Bacteroides spp. (table). 18 (26%) patients had multiple different species of obligate anaerobes recovered. 8 infected patients had the same organism isolated on repeat culture (>7 days apart)  despite active antimicrobial being provided. Five (7.2%) patients died during initial hospitalization, but there was no attributable mortality related to infections with obligate anaerobes. 

     

    Total

    Intra-abdominal

    Upper Ext

    Pelvic

    Lower Ext

    Other*

    # of isolates (# of patients )

    84 (61)

    12 (7)

    6 (5)

    16 (13)

    37 (31)

    13 (11)

    ISS** median (min-max)

    21 (4-66)

    24 (12-50)

    22 (17-33)

    27 (12-38)

    18 (4-66)

    21 (4-43)

    Days injury to culture

    13 (1-401)

    12 (3-47)

    8 (5-50)

    11 (5-95)

    15 (3-401)

    7 (1-238)

    B. fragilis

    15 (16)

    1 (1)

    0

    4 (4)

    9 (9)

    1

    B. non-fragilis

    16 (16)

    4 (4)

    0

    7 (7)

    5 (5)

    0

    F. magna

    9 (14)

    0

    0

    2 (2)

    7 (7)

    2 (2)

    Clostridium spp.

    16 (14)

    1 (1)

    6 (5)

    1 (1)

    6 (5)

    2 (1)

    P. acnes

    9 (9)

    0

    0

    0

    4 (4)

    5 (5)

    Other

    19 (15)

    6 (4)

    0

    2 (2)

    6 (6)

    4 (3)

    *Blood, Respiratory, Head wound, CSF

    **ISS-Injury Severity Score

    Conclusion: Obligate anaerobes can be isolated from war wounds more than 2 weeks after injury, which is later than previously noted. The majority of war wounds with anaerobic infection were caused by Bacteroides spp.

    Brian White, DO1, Amy Weintrob, MD2, Katrin Mende, PhD3, Miriam Beckius, MPH4, Wendy Zera, BS5, Dan Lu, MS6, William P. Bradley, MS6, David Tribble, MD, DrPH6, Clinton K. Murray, MD7 and Elizabeth Rini, MD8, (1)Infectious Disease Service, San Antonio Military Medical Center, JBSA San Antonio, TX, (2)Infectious Disease Clinical Research Program, Washington DC, DC, (3)Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, MD, (4)San Antonio Military Medical Center, JBSA Fort Sam Houston, TX, (5)Infectious Disease Clinical Research Program, Fort Sam Houston, TX, (6)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, (7)Brooke Army Medical Center, Ft. Sam Houston, TX, (8)Landstuhl Regional Medical Center, APO, AE

    Disclosures:

    B. White, None

    A. Weintrob, None

    K. Mende, None

    M. Beckius, None

    W. Zera, None

    D. Lu, None

    W. P. Bradley, None

    D. Tribble, None

    C. K. Murray, None

    E. Rini, None

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