Posted on 10/23/2005 7:36:48 AM PDT by Flavius
BETHESDA, Md. (AP) -- Among the casualties treated aboard the hospital ship USNS Comfort in the early weeks of the 2003 invasion of Iraq was a civilian shot multiple times while caught in crossfire. The patient was seriously wounded, but stabilized after emergency surgery.
But 24 hours later, the Iraqi was dead after bleeding uncontrollably from his wounds, his blood poisoned by an unknown infection that didn't respond to antibiotics.
Within a week, about a quarter of the injured troops on the ship in the Persian Gulf had the same bacteria. Soon, another Iraqi in the intensive care unit died. With so many wounded people in close quarters, Navy doctors worried the infection could keep spreading.
"It was an incredible amount of patients to try to keep on top of," said Lt. Cmdr. Kyle Petersen, the infectious disease specialist aboard the ship. "The potential for spread was really high."
Doctors soon identified the bug -- a bacterium called Acinetobacter baumannii. Commonly found in soil worldwide, it is not often among the stew of germs that can pop up in hospitals.
Since the fighting began in Iraq, the number of Acinetobacter cases among wounded troops has jumped significantly at military hospitals such as the National Naval Medical Center in Bethesda, Walter Reed Army Medical Center in Washington and Landstuhl Regional Medical Center in Germany. Many are infected, while others simply carry it on their skin.
At the naval hospital, the number of battle casualties with the bacterium spiked from about six in 2002 to 193 from May 2003 to July 2005, about 30 percent of the wounded the hospital has admitted. The Army, which saw about five cases at Walter Reed and Landstuhl each year, reported as many as 10 cases per month, according to Col. Bruno Petrucelli, head of epidemiology for the U.S. Army Center for Health Promotion and Preventive Medicine.
In all, the Army had around 240 cases from January 2002 to March 2005.
"By definition, it is an outbreak," Petrucelli said.
Left untreated, the bacterium can lead to pneumonia, fever and unchecked bleeding. No active-duty troops wounded in Iraq or Afghanistan, where cases have also surfaced, have died. But there has been a small number of fatalities among patients in hospitals where wounded are treated, mostly elderly or severely ill people.
The number of cases has dipped recently as hospitals installed procedures to test every patient for the bacterium and isolate those who show signs of it.
Doctors are leery of treating it too aggressively with antibiotics for fear it could evolve into a strain able to stave off even the most potent drugs. In the most severe cases, doctors have used an older antibiotic, colistin, when other "last-resort" drugs such as imipenem or meropenem didn't work, Petrucelli said. Doctors had largely stopped using colistin because of concerns over its effects on the kidneys.
Marine Lance Cpl. Matthew Schilling was badly injured Aug. 26 by a roadside bomb while on patrol in the Iraqi city of Hit. Evacuated to an air base, surgeons amputated one of his lower legs and treated his mangled left hand.
About a week later, he was transferred to the National Naval Medical Center, where doctors discovered an Acinetobacter infection in his blood. He was kept in isolation and treated with antibiotics, a regimen that cured him. He didn't feel the effects of the bacteria, but found it a bit unsettling when he was told of the infection.
"I didn't know how bad it was or how to get rid of it or what they would do," said Schilling, a reservist from Ellwood City, Pa. "But they handled it pretty quickly."
Acinetobacter showed up in small numbers during the Vietnam War but has been relatively rare in military hospitals since then. Petersen, based at Bethesda, had only read about it during medical training.
It is unclear what triggered the jump in cases from Iraq. Petrucelli said it may come from forward field hospitals where doctors struggle to keep operating rooms sanitized as often dirty and badly wounded patients are brought in.
From there, the bacterium tags along as the patients flow through the military medical system, often to Landstuhl and then on to a U.S. military hospital. Tests have tracked that movement -- the genetic makeup of Acinetobacter in intensive care units in Baghdad matched some at Walter Reed, Petrucelli said.
Petersen theorizes the nature of the wounds may be to blame. Many soldiers and Marines are injured by roadside bombs, explosions that spray shrapnel, dirt and other material that could carry bacteria into deep wounds. From there, it can spread as those troops are treated in hospitals -- one study linked 40 cases to one field hospital operating table.
Similar cases of Acinetobacter were seen in victims of the 2002 Bali bombings and last year's tsunami in Asia, both cases where people suffered wounds from projectiles.
"I don't think we've figured out the whole story here," he said.
Meanwhile, military hospitals are testing all incoming patients for the bacterium and isolating them as the results are pending. Those that show signs on their skin or infections stay in isolation, although their families can visit them. Doctors wear gloves and gowns when they treat those patients. A similar technique, along with emergency shipments of antibiotics, helped quell the 2003 outbreak on the Comfort.
"Whenever people come from Iraq, we automatically assume they are colonized," with the bacterium, said Judith English, the naval hospital's head of infection control.
(Copyright 2005 by The Associated Press. All Rights Reserved.)
It's because US military "medicine" overuses antibiotics.
This critter is often brought out by deep diggin in the soil around a hospital or nursing home due to construction or demolition of an old wing of a hospital or nursing home.
A mortar shell or a cannon round exploding on/in the ground can bring up these critters. If a person has been wounded and gets contaminated dust or dirt on them, they can be infected.
It can be in untreated or improperly treated water.
http://www.cdc.gov/ncidod/hip/ARESIST/acin_general.htm
Acinetobacter Infection
General Information
September 24, 2004
What is Acinetobacter?
Acinetobacter (ass in ée toe back ter) is a group of bacteria commonly found in soil and water. It can also be found on the skin of healthy people, especially healthcare personnel. While there are many types or “species” of Acinetobacter and all can cause human disease, Acinetobacter baumannii accounts for about 80% of reported infections.
Outbreaks of Acinetobacter infections typically occur in intensive care units and healthcare settings housing very ill patients. Acinetobacter infections rarely occur outside of healthcare settings.
What are the symptoms of Acinetobacter infection?
Acinetobacter causes a variety of diseases, ranging from pneumonia to serious blood or wound infections and the symptoms vary depending on the disease. Typical symptoms of pneumonia could include fever, chills, or cough. Acinetobacter may also “colonize” or live in a patient without causing infection or symptoms, especially in tracheostomy sites or open wounds.
How do people get Acinetobacter infection?
Acinetobacter poses very little risk to healthy people. However, people who have weakened immune systems, chronic lung disease, or diabetes may be more susceptible to infections with Acinetobacter.Hospitalized patients, especially very ill patients on a ventilator, those with a prolonged hospital stay, or those who have open wounds, are also at greater risk for Acinetobacter infection. Acinetobactercan be spread to susceptible persons by person-to-person contact, contact with contaminated surfaces, or exposure in the environment.
How is Acinetobacter infection treated?
Acinetobacter is often resistant to many commonly prescribed antibiotics. Decisions on treatment of infections with Acinetobacter should be made on a case-by-case basis by a healthcare provider. Acinetobacter infection typically occurs in very ill patients and can either cause or contribute to death in these patients.
What should I do to prevent the spread of Acinetobacter infection to others?
Acinetobacter can live on the skin and may survive in the environment for several days. Careful attention to infection control procedures such as hand hygiene and environmental cleaning can reduce the risk of transmission.
For more information on infection control practices and hand hygiene, see http://www.cdc.gov/handhygiene and http://www.cdc.gov/ncidod/hip/ISOLAT/Isolat.html.
No, "A baumannii is a multiresistant aerobic gram-negative bacillus sensitive to relatively few antibiotics. Multidrug-resistant Acinetobacter is not a new or emerging phenomenon, but A baumannii has always been an organism inherently resistant to multiple antibiotics."
Whenever we finally say goodbye to Iraq, we will be amazed to see all the caves and tunnel networks that are all over Iraq. A professor of mine that has done numerous archeological digs in Iraq told me about the existence of thousands of family hideaways that are located all over the country and handed down through families for generations like vacation cottages are here in the USA.
Disclaimer: Opinions posted on Free Republic are those of the individual posters and do not necessarily represent the opinion of Free Republic or its management. All materials posted herein are protected by copyright law and the exemption for fair use of copyrighted works.