1551. Combat-related Extremity Wound Infection Epidemiology: Trauma Infectious Disease Outcomes Study 2009-2012
Session: Poster Abstract Session: Clinical Infectious Diseases: Combat Wounds
Saturday, October 10, 2015
Room: Poster Hall
Background: Extremity injuries are a common consequence of modern warfare frequently complicated by infections. Treatment is often further challenged due to the presence of multidrug-resistant bacteria. We describe the epidemiology of extremity wounds and infections among US military patients injured in Iraq and Afghanistan (2009-2012).

Methods: Utilizing the Trauma Infectious Disease Outcome Study (TIDOS) population, all patients with combat-related, open extremity wounds admitted to Landstuhl Regional Medical Center and subsequently transferred to a participating US hospital, were included in the analysis. Wounds were categorized into 3 groups: amputation (which includes amputation only or amputations that occurred at the same site as a fracture), open fracture (which includes fractures with/without another open wound at the same site), and ‘other’ (open wounds without open fractures or amputations).

Results: A total of 1858 patients were admitted for a combat-related injury, of which, 1466 had at least one open extremity wound. The majority (93.5%) served in Afghanistan, while 7.1% served in Iraq. The median injury severity score was 21. The total number of open extremity wounds was 4826: 711 amputations, 1274 open fractures, and 2841 other wounds. On average, there were 3.3 wounds per patient. The overall open extremity wound infection rate was 10.1%. Of these infections the majority were located in the upper leg (260), followed by the lower leg (89) Wound-specific infection rates were 39.3%, 11.8%, and 2% for amputations, open fractures, and other open wounds, respectively. Additionally, 85% of amputation infections were skin and soft-tissue infections (SSTI). The remaining 15% of infections were due to osteomyelitis (OSTEO). Of the 150 infections associated with open fractures, 67.3% were due to SSTI and 33% OSTEO. Lastly, 86.2% of infections in other open wounds were due to SSTI with 13.8% due to OSTEO.

Conclusion: The highest rate of infection occurred with amputations accounting for approximately 60% of all infections. Fractures represented 30% and other open wounds only 12%. Overall, these data contribute to a better understanding of infection risk associated with combat extremity wounds.  Future efforts will investigate wound microbiology and clinical outcomes to inform clinical practice for extremity wound management during wartime.

Laveta Stewart, PhD, MSc, MPH1,2, Faraz Shaikh, MS1,2, William P. Bradley, MS1,3,4, Dan Z. Lu, MS1,2, Clinton K. Murray, MD, FIDSA3, Elizabeth Rini, MD5, Timothy Whitman, DO6, Margot Krauss, MD, MPH, FACPM7, Lauren Greenberg, MPH7 and David Tribble, MD, DrPH1, (1)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, (2)The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Rockville, MD, (3)San Antonio Military Medical Center, JBSA Fort Sam Houston, TX, (4)Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, (5)Landstuhl Regional Medical Center, APO, AE, (6)Walter Reed National Military Medical Center, Bethesda, MD, (7)Westat, Rockville, MD


L. Stewart, None

F. Shaikh, None

W. P. Bradley, None

D. Z. Lu, None

C. K. Murray, None

E. Rini, None

T. Whitman, None

M. Krauss, None

L. Greenberg, None

D. Tribble, None

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