Impact of Operational Theater on Combat and Noncombat Trauma-Related Infections

Abstract

The Trauma Infectious Disease Outcomes Study began in June 2009 as combat operations were decreasing in Iraq and increasing in Afghanistan. Our analysis examines the rate of infections of wounded U.S military personnel from operational theaters in Iraq and Afghanistan admitted to Landstuhl Regional Medical Center between June 2009 and December 2013 and transferred to a participating U.S. hospital. Infection risk factors were examined in a multivariate logistic regression analysis (expressed as odds ratios [OR]; 95% confidence intervals [CI]). The study population includes 524 wounded military personnel from Iraq and 4766 from Afghanistan. The proportion of patients with at least one infection was 28% and 34% from the Iraq and Afghanistan theaters, respectively. The incidence density rate was 2.0 (per 100 person-days) for Iraq and 2.7 infections for Afghanistan. Independent risk factors included large-volume blood product transfusions (OR: 10.68; CI: 6.73–16.95), high injury severity score (OR: 2.48; CI: 1.81–3.41), and improvised explosive device injury mechanism (OR: 1.84; CI: 1.35–2.49). Operational theater (OR: 1.32; CI: 0.87–1.99) was not a risk factor. The difference in infection rates between operational theaters is primarily due to increased injury severity in Afghanistan from a higher proportion of blast-related trauma during the study period.

Association ofEnterococcusspp. with Severe Combat Extremity Injury, Intensive Care, and Polymicrobial Wound Infection

“…Both the case and comparator groups in this study included a high proportion of blast-injured subjects with severe and complex injuries to both the upper and lower extremities. Although our study does not break out injuries based on pattern, the incidence of SSTIs and osteomyelitis is consistent with previously reported proportions of infections associated with soft-tissue injuries and fracture [14,36,45].…”

An Initial Investigation of Unmanned Aircraft Systems (UAS) and Real-Time Organ Status Measurement for Transporting Human Organs

“…Additionally, a related regulatory hurdle is that of integration with preexisting aircraft operations and airspace. If drone regulations were to change, organ and potentially blood transportation might represent ideal initial use-cases [20] , [21] . Further, success with transplantation could open up the possibility of additional, future UAS applications.…”

Management of Acute Diarrheal Illness During Deployment: A Deployment Health Guideline and Expert Panel Report

“…17,35,108,109 From a military perspective, antibiotic resistance is undoubtedly an important concern. Trauma-related infections among combat casualties are a substantial challenge 110–112 with attendant morbidity and mortality 113–118 and complicated by multidrug resistance. 117,119–121 While needing further study, the multitude of exposures from environmental, as well as additional factors, such as daily antimalarial prophylaxis, stress to the immune system, perioperative antibiotic prophylaxis among injured personnel, and duration of deployment are strong contributors to multidrug-resistant organism colonization acquisition 122 and, thus, the attributable fraction of TD treatment with single-dose antibiotics needs to be put into appropriate perspective and balanced against the clear FHP benefits of effective therapy for consequential moderate-severe TD infections.…”