1158. Microbiological profile of combat-related extremity wound infections: Trauma Infectious Disease Outcomes Study 2009-2012
Session: Poster Abstract Session: Clinical Infectious Diseases: Bone and Joint, Skin and Soft Tissue
Friday, October 28, 2016
Room: Poster Hall
Background: Extremity injuries are a common consequence of modern warfare frequently complicated by infections. Treatment is further challenged by the presence of multidrug-resistant bacteria. We describe the preliminary microbiological profile of combat-related open extremity wound infections among US military patients injured in Iraq and Afghanistan (2009-2012).

Methods: Utilizing the Trauma Infectious Disease Outcomes Study population, all patients with a combat-related open extremity wound admitted to Landstuhl Regional Medical Center (LRMC) prior to transfer to a participating US hospital were assessed for infectious outcomes and microbial recovery. Only wound, bone or synovial specimens from patients who had a confirmed infection at extremity wound sites were included.

Results: A total of 1409 patients had >1 combat-related open extremity wound, of which 323 (23%) had an infection at the wound site. Microbiological work-up was conducted for 263 patients. Of these, 250 had infected wounds with organism recovery [89 (36%) had only monomicrobial infections, while 161 patients (64%) had any polymicrobial infection]. In total, there were 335 infections; 131 (39%) monomicrobial and 204 (61%) polymicrobial. Monomicrobial infections were predominately bacteria (57% aerobic gram negative, 23% gram positive, and 5% anaerobic bacteria). Polymicrobial infections were primarily bacteria alone (61%), followed by bacteria and mold (30%). A statistically significant difference was found between patients with only monomicrobial infections and patients with any polymicrobial infections by number of infected limbs with microbial recovery, injury severity score, injury type and ICU admission at LRMC or US; p<0.05. No statistical differences for these groups were found by number of limbs injured or body region of infected wound.

Conclusion: Overall, 95% of patients with an infected wound had an organism recovered, predominately polymicrobial, when microbiological work-up was conducted. Future analyses will assess associations of subject, wound and clinical care factors with infectious outcomes to inform clinical practice for extremity wound management.

Laveta Stewart, PhD, MSc, MPH1,2, Faraz Shaikh, MS1,2, William P. Bradley, MS1,2,3, Dan Z. Lu, MS1,2, Dana M. Blyth, M.D.3, Elizabeth Schnaubelt, MD4, Timothy Whitman, DO5, Margot Krauss, MD, MPH, FACPM6, Lauren Greenberg, MPH6, Katrin Mende, PhD7 and David Tribble, MD, DrPH, FIDSA2, (1)Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, (2)Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, (3)San Antonio Military Medical Center, JBSA Fort Sam Houston, TX, (4)Landstuhl Regional Medical Center, Landstuhl, Germany, (5)Walter Reed National Military Medical Center, Bethesda, MD, (6)Westat, Rockville, MD, (7)Department of Clinical Investigation, San Antonio Military Medical Center, Fort Sam Houston, TX


L. Stewart, None

F. Shaikh, None

W. P. Bradley, None

D. Z. Lu, None

D. M. Blyth, None

E. Schnaubelt, None

T. Whitman, None

M. Krauss, None

L. Greenberg, None

K. Mende, None

D. Tribble, None

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