1552. Infections after deployment polytrauma: Following wounded US military personnel into VA care
Session: Poster Abstract Session: Clinical Infectious Diseases: Combat Wounds
Saturday, October 10, 2015
Room: Poster Hall

Background:  Infectious complications after deployment polytrauma contribute significantly to morbidity and mortality.  The Trauma Infectious Disease Outcomes Study (TIDOS) enrolled 1371 subjects injured in Iraq and Afghanistan in a prospective observational cohort study of infectious complications. We present Department of Defense (DOD) and Department of Veterans Affairs (VA) data from the first 337 TIDOS enrollees to receive VA healthcare.

Methods:   Demographics, initial medical care, infectious complications (e.g. microbiology and treatment), and relevant covariates (e.g. mental health and social covariates) were collected from DOD and VA data sources.  Statistical analyses were performed to identify candidate predictors of infection related to deployment polytrauma.

Results:   As of March 2015, 1,152 (84%) of TIDOS enrollees entered VA care. Complete DOD-VA data was available for 337 subjects, of which 110 (33%) had ≥1 polytrauma-related infection during initial hospitalization. Also 133 (40%) developed ≥1 new polytrauma-related infection following first DOD discharge; 72% were diagnosed in DOD care and 28% in VA care.  On per infection basis, skin/soft tissue infections (SSTI) (66%), osteomyelitis (12%), and urinary tract infections (UTI) (7%) predominated.  Infections diagnosed after initial discharge were associated with higher injury severity scores (p<0.001), massive blood transfusion (p<0.001), any infection identified at time of injury (p<0.001), and antimicrobial therapy received within 48 hrs of injury (p=0.018).  Infections were more likely in those hospitalized for longer durations after injury (p<0.001).  While the proportion of SSTI (67% v 62%) and osteomyelitis (13% v 10%) was similar in DOD v VA care, UTI (2% vs. 21%) was more heavily represented in VA care. Infections diagnosed after first DOD discharge were most commonly caused by Staph aureus (33%), coagulase-negative Staphylococci (11%), and Pseudomonas aeruginosa (8%).

Conclusion:   Infectious complications are common after deployment polytrauma, particularly within the first 30 days of DOD care and in the setting of severe injury.  However, incident infections related to deployment polytrauma continue well after initial hospital discharge and even into VA care.

Jay Mcdonald, MD1,2, Stephen Liang, MD2, Ping Li, MS3,4, Salwa Maalouf, MA, MPH1, Clinton K. Murray, MD, FIDSA5, Amy Weintrob, MD3,4,6, Elizabeth Rini, MD7, Janis Kuhn, MEd1,2, Anuradha Ganesan, MD, MPH3,8, Deepak Aggarwal, MSE, MSPH3,4, William P. Bradley, MS3,4, David Tribble, MD, DrPH, FIDSA3 and the Infectious Disease Clinical Research Program Trauma Infectious Disease Outcomes Study Group, (1)Medicine Service, Veterans Affairs St. Louis Health Care System, St. Louis, MO, (2)Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, (3)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, (4)Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, (5)Infectious Disease Service, Brooke Army Medical Center, Fort Sam Houston, TX, (6)Walter Reed National Military Medical Center, Bethesda, MD, (7)Landstuhl Regional Medical Center, APO, AE, (8)Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD

Disclosures:

J. Mcdonald, None

S. Liang, None

P. Li, None

S. Maalouf, None

C. K. Murray, None

A. Weintrob, None

E. Rini, None

J. Kuhn, None

A. Ganesan, None

D. Aggarwal, None

W. P. Bradley, None

D. Tribble, None

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