An outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus complex infection in the US military health care system associated with military operations in Iraq

Paul Scott, Gregory Deye, Arjun Srinivasan, Clinton Murray, Kimberly Moran, Ed Hulten, Joel Fishbain, David Craft, Scott Riddell, Luther Lindler, James Mancuso, Eric Milstrey, Christian T. Bautista, Jean Patel, Alessa Ewell, Tacita Hamilton, Charla Gaddy, Martin Tenney, George Christopher, Kyle PetersenTimothy Endy, Bruno Petruccelli

Research output: Contribution to journalArticle

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Abstract

Background. We investigated an outbreak of multidrug-resistant Acinetobacter baumcwnii-calcoaceticus complex infection among US service members injured in Iraq. Methods. The investigation was conducted in Iraq and Kuwait, in the 2 military hospitals where the majority of injured service members were initially treated. After initially characterizing the outbreak, we evaluated 3 potential sources of infection for the period March 2003 to December 2004. The evaluation included screening samples that were obtained from the skin of patients for the presence of colonization and assessing the soil and health care environments for the presence of A. baumanii-calcoaceticus complex organisms. Isolates obtained from samples from patients in US Military treatment facilities, as well as environmental isolates, were genotypically characterized and compared using pulsed-field gel electrophoresis. Results. A. baumanii-calcoaceticus complex organisms were present on the skin in only 1 (0.6%) of 160 patients who were screened and in 1 (2%) of 49 soil samples. A. baumanii-calcoaceticus complex isolates were recovered from treatment areas in 7 of the 7 field hospitals sampled. Using pulsed-field gel electrophoresis, we identified 5 cluster groups in which isolates from patients were related to environmental isolates. One cluster included hospitalized patients who had not been deployed to Iraq. Among the clinical isolates, only imipenem, polymyxin B, and colistin demonstrated reliable in vitro antimicrobial activity. Generally, the environmental isolates were more drug susceptible than were the clinical isolates. Conclusions. Our findings suggest that environmental contamination of field hospitals and infection transmission within health care facilities played a major role in this outbreak. On the basis of these findings, maintaining infection control throughout the military health care system is essential. Novel strategies maybe required to prevent the transmission of pathogens in combat field hospitals.

Original languageEnglish (US)
Pages (from-to)1577-1584
Number of pages8
JournalClinical Infectious Diseases
Volume44
Issue number12
DOIs
StatePublished - Jun 15 2007

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Acinetobacter calcoaceticus
Acinetobacter baumannii
Iraq
Disease Outbreaks
Mobile Health Units
Delivery of Health Care
Infection
Infectious Disease Transmission
Pulsed Field Gel Electrophoresis
Soil
Military Facilities
Kuwait
Colistin
Polymyxin B
Military Hospitals
Skin
Imipenem
Health Facilities
Infection Control
Cross Infection

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Scott, Paul ; Deye, Gregory ; Srinivasan, Arjun ; Murray, Clinton ; Moran, Kimberly ; Hulten, Ed ; Fishbain, Joel ; Craft, David ; Riddell, Scott ; Lindler, Luther ; Mancuso, James ; Milstrey, Eric ; Bautista, Christian T. ; Patel, Jean ; Ewell, Alessa ; Hamilton, Tacita ; Gaddy, Charla ; Tenney, Martin ; Christopher, George ; Petersen, Kyle ; Endy, Timothy ; Petruccelli, Bruno. / An outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus complex infection in the US military health care system associated with military operations in Iraq. In: Clinical Infectious Diseases. 2007 ; Vol. 44, No. 12. pp. 1577-1584.
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title = "An outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus complex infection in the US military health care system associated with military operations in Iraq",
abstract = "Background. We investigated an outbreak of multidrug-resistant Acinetobacter baumcwnii-calcoaceticus complex infection among US service members injured in Iraq. Methods. The investigation was conducted in Iraq and Kuwait, in the 2 military hospitals where the majority of injured service members were initially treated. After initially characterizing the outbreak, we evaluated 3 potential sources of infection for the period March 2003 to December 2004. The evaluation included screening samples that were obtained from the skin of patients for the presence of colonization and assessing the soil and health care environments for the presence of A. baumanii-calcoaceticus complex organisms. Isolates obtained from samples from patients in US Military treatment facilities, as well as environmental isolates, were genotypically characterized and compared using pulsed-field gel electrophoresis. Results. A. baumanii-calcoaceticus complex organisms were present on the skin in only 1 (0.6{\%}) of 160 patients who were screened and in 1 (2{\%}) of 49 soil samples. A. baumanii-calcoaceticus complex isolates were recovered from treatment areas in 7 of the 7 field hospitals sampled. Using pulsed-field gel electrophoresis, we identified 5 cluster groups in which isolates from patients were related to environmental isolates. One cluster included hospitalized patients who had not been deployed to Iraq. Among the clinical isolates, only imipenem, polymyxin B, and colistin demonstrated reliable in vitro antimicrobial activity. Generally, the environmental isolates were more drug susceptible than were the clinical isolates. Conclusions. Our findings suggest that environmental contamination of field hospitals and infection transmission within health care facilities played a major role in this outbreak. On the basis of these findings, maintaining infection control throughout the military health care system is essential. Novel strategies maybe required to prevent the transmission of pathogens in combat field hospitals.",
author = "Paul Scott and Gregory Deye and Arjun Srinivasan and Clinton Murray and Kimberly Moran and Ed Hulten and Joel Fishbain and David Craft and Scott Riddell and Luther Lindler and James Mancuso and Eric Milstrey and Bautista, {Christian T.} and Jean Patel and Alessa Ewell and Tacita Hamilton and Charla Gaddy and Martin Tenney and George Christopher and Kyle Petersen and Timothy Endy and Bruno Petruccelli",
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Scott, P, Deye, G, Srinivasan, A, Murray, C, Moran, K, Hulten, E, Fishbain, J, Craft, D, Riddell, S, Lindler, L, Mancuso, J, Milstrey, E, Bautista, CT, Patel, J, Ewell, A, Hamilton, T, Gaddy, C, Tenney, M, Christopher, G, Petersen, K, Endy, T & Petruccelli, B 2007, 'An outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus complex infection in the US military health care system associated with military operations in Iraq', Clinical Infectious Diseases, vol. 44, no. 12, pp. 1577-1584. https://doi.org/10.1086/518170

An outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus complex infection in the US military health care system associated with military operations in Iraq. / Scott, Paul; Deye, Gregory; Srinivasan, Arjun; Murray, Clinton; Moran, Kimberly; Hulten, Ed; Fishbain, Joel; Craft, David; Riddell, Scott; Lindler, Luther; Mancuso, James; Milstrey, Eric; Bautista, Christian T.; Patel, Jean; Ewell, Alessa; Hamilton, Tacita; Gaddy, Charla; Tenney, Martin; Christopher, George; Petersen, Kyle; Endy, Timothy; Petruccelli, Bruno.

In: Clinical Infectious Diseases, Vol. 44, No. 12, 15.06.2007, p. 1577-1584.

Research output: Contribution to journalArticle

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T1 - An outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus complex infection in the US military health care system associated with military operations in Iraq

AU - Scott, Paul

AU - Deye, Gregory

AU - Srinivasan, Arjun

AU - Murray, Clinton

AU - Moran, Kimberly

AU - Hulten, Ed

AU - Fishbain, Joel

AU - Craft, David

AU - Riddell, Scott

AU - Lindler, Luther

AU - Mancuso, James

AU - Milstrey, Eric

AU - Bautista, Christian T.

AU - Patel, Jean

AU - Ewell, Alessa

AU - Hamilton, Tacita

AU - Gaddy, Charla

AU - Tenney, Martin

AU - Christopher, George

AU - Petersen, Kyle

AU - Endy, Timothy

AU - Petruccelli, Bruno

PY - 2007/6/15

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N2 - Background. We investigated an outbreak of multidrug-resistant Acinetobacter baumcwnii-calcoaceticus complex infection among US service members injured in Iraq. Methods. The investigation was conducted in Iraq and Kuwait, in the 2 military hospitals where the majority of injured service members were initially treated. After initially characterizing the outbreak, we evaluated 3 potential sources of infection for the period March 2003 to December 2004. The evaluation included screening samples that were obtained from the skin of patients for the presence of colonization and assessing the soil and health care environments for the presence of A. baumanii-calcoaceticus complex organisms. Isolates obtained from samples from patients in US Military treatment facilities, as well as environmental isolates, were genotypically characterized and compared using pulsed-field gel electrophoresis. Results. A. baumanii-calcoaceticus complex organisms were present on the skin in only 1 (0.6%) of 160 patients who were screened and in 1 (2%) of 49 soil samples. A. baumanii-calcoaceticus complex isolates were recovered from treatment areas in 7 of the 7 field hospitals sampled. Using pulsed-field gel electrophoresis, we identified 5 cluster groups in which isolates from patients were related to environmental isolates. One cluster included hospitalized patients who had not been deployed to Iraq. Among the clinical isolates, only imipenem, polymyxin B, and colistin demonstrated reliable in vitro antimicrobial activity. Generally, the environmental isolates were more drug susceptible than were the clinical isolates. Conclusions. Our findings suggest that environmental contamination of field hospitals and infection transmission within health care facilities played a major role in this outbreak. On the basis of these findings, maintaining infection control throughout the military health care system is essential. Novel strategies maybe required to prevent the transmission of pathogens in combat field hospitals.

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