Multidrug-resistant Acinetobacter extremity infections in soldiers

Abstract

War wound infection and osteomyelitis caused by multidrug-resistant (MDR) Acinetobacter species have been prevalent during the 2003-2005 military operations in Iraq. Twenty-three soldiers wounded in Iraq and subsequently admitted to our facility from March 2003 to May 2004 had wound cultures positive for Acinetobacter calcoaceticus-baumannii complex. Eighteen had osteomyelitis, 2 burn infection, and 3 deep wound infection. Primary therapy for these infections was directed antimicrobial agents for an average of 6 weeks. All soldiers initially improved, regardless of the specific type of therapy. Patients were followed up to 23 months after completing therapy, and none had recurrent infection with Acinetobacter species. Despite the drug resistance that infecting organisms demonstrated in this series, a regimen of carefully selected extended antimicrobial-drug therapy appears effective for osteomyelitis caused by MDR Acinetobacter spp.

Figure

Flow chart illustrating active-duty soldier admissions to Brooke Army Medical Center from March 1, 2003, to May 31, 2004, and those who met case definitions for Acinetobacter osteomyelitis or wound infection. *Soldiers with diagnosis of injury, ICD codes 800.0–900.0. OIF/OEF, Operation Iraqi Freedom/Operation Enduring Freedom.