The potential benefit of 5% Sulfamylon Solution in the treatment of Acinetobacter baumannii-contaminated traumatic war wounds

Abstract

Background: The recent report of high numbers of Acinetobacter baumannii bloodstream infections among service members injured in Iraq and Afghanistan during the period January 2002 through August 2004 has prompted an investigation into their etiology. A review of the current guidelines for open combat casualty wounds as part of this broad investigation was not mentioned in the report.

Objective: The objective of this study was 2-fold: to ascertain the susceptibility of A. baumannii to currently available topical antibacterial agents and (2) to propose an alternative, effective treatment protocol for contaminated combat-related wounds so as to reduce or eliminate the likelihood of the wound serving as the source of A. baumannii infection or septicemia.

Methods: A standardized antimicrobial susceptibility study of 43 strains of A. baumannii collected from a tertiary care burn center was conducted using 2 commonly used topical antibacterial agents, 1% silver sulfadiazine cream (Silvadene) and 5% mafenide acetate solution (5% Sulfamylon Solution).

Results: Both were effective, but 5% Sulfamylon Solution demonstrated significantly greater antibacterial activity.

Conclusion: Five percent Sulfamylon Solution, initially developed for wartime use, and currently limited by the Food and Drug Administration to soaks following meshed split-thickness autografts following excision of second-degree and third-degree burns, has a broad spectrum of antibacterial activity and extensive off-label applicability. It is an ideal agent for use in the treatment of war wounds, and should be considered as a superior replacement for normal saline in the current guidelines for open combat casualty wounds.

Figure 1

Patient with burns, traumatic amputation left foot and lower leg, and multiple soft tissue injuries secondary to blast (Afghanistan, 2003).

Figure 2

Debrided shrapnel wounds to right thigh, flank, and abdomen (Afghanistan, 2003).

Figure 3

Surgical team in action (Afghanistan, 2003).

Figure 4

Normal saline–soaked dressing being applied to open abdominal wound (Afghanistan, 2003).