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High Incidence of Multidrug-Resistant Gram-Negative Bacteria Recovered from Afghan Patients at a Deployed US Military Hospital

Published online by Cambridge University Press:  02 January 2015

Deena E. Sutter*
Affiliation:
Department of Pediatrics, Wilford Hall Medical Center, Lackland Air Force Base, Texas
Linda U. Bradshaw
Affiliation:
Department of Pediatrics, Wilford Hall Medical Center, Lackland Air Force Base, Texas
Lucas H. Simkins
Affiliation:
507th Medical Squadron, Tinker Air Force Base, Oklahoma
Amy M. Summers
Affiliation:
Department of Pathology and Area Laboratory Support, Department of Medicine, Walter Reed Army Medical Center, Washington, DC
Michael Atha
Affiliation:
Department of Medicine, Travis Air Force Base, California
Robert L. Elwood
Affiliation:
Department of Pediatrics, Wilford Hall Medical Center, Lackland Air Force Base, Texas
Janelle L. Robertson
Affiliation:
Department of Medicine, Elgin Hospital, Elgin Air Force Base, Florida
Clinton K. Murray
Affiliation:
Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, Texas
Glenn W. Wortmann
Affiliation:
Infectious Disease Service, Department of Medicine, Walter Reed Army Medical Center, Washington, DC
Duane R. Hospenthal
Affiliation:
Infectious Disease Service, San Antonio Military Medical Center, Fort Sam Houston, Texas
*
Department of Pediatrics, San Antonio Military Medical Center, 3851 Roger Brooke Drive, Fort Sam Houston, TX 78234 (deena.sutter@amedd.army.mil)

Abstract

Objective.

To investigate potential sources and risks associated with multidrug-resistant (MDR) bacteria in a deployed US military hospital.

Design.

Retrospective analysis of factors associated with recovery of MDR bacteria, supplemented by environmental sampling.

Setting.

The largest US military hospital in Afghanistan.

Patients.

US and Afghan patients with positive bacterial culture results, from September 2007 through August 2008.

Methods.

Microbiologic, demographic, and clinical data were analyzed. Potential risk factors included admission diagnosis or mechanism of injury, length of stay, gender, age, and nationality (US or Afghan). Environmental sampling of selected hospital high-touch surfaces and equipment was performed to help elucidate whether environmental MDR bacteria were contributing to nosocomial spread.

Results.

A total of 266 patients had 411 bacterial isolates that were identified during the study period, including 211 MDR bacteria (51%). Gram-negative bacteria were common among Afghan patients (241 [76%] of 319), and 70% of these were classified as MDR. This included 58% of bacteria recovered from Afghan patients within 48 hours of hospital admission. The most common gram-negative bacteria were Escherichia coli (53% were MDR), Acinetobacter (90% were MDR), and Klebsiella (63% were MDR). Almost one-half of potential extended-spectrum β-lactamase (ESBL) producers were community acquired. Of 100 environmental swab samples, 18 yielded MDR bacteria, including 10 that were Acinetobacter, but no potential ESBL-producing bacteria.

Conclusions.

Gram-negative bacteria from Afghan patients had high rates of antimicrobial resistance. Patients experiencing Complex trauma and prolonged hospital stays likely contribute to the presence of MDR bacteria in this facility. However, many of these patients had community-acquired cases, which implies high rates of colonization prior to hospital admission.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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