The majority of US combat casualty soft-tissue wounds are not infected or colonized upon arrival or during treatment at a continental US military medical facility

Sheppard, Forest R.; Keiser, Paul B.; Craft, David W.; Gage, Fred; Robson, Martin C.; Brown, Trevor S.; Petersen, Kyle; Sincock, Stephanie A.; Kasper, Matt; Hawksworth, Jason; Tadaki, Douglas K.; Davis, Thomas A.; Stojadinovic, Alexander; Elster, Eric A.

doi:10.1016/j.amjsurg.2010.03.001

Cited by 67 publications

(55 citation statements)

References 8 publications

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“…Preliminary experiments demonstrated that the bacterial concentration of MRSA used in these studies resulted in established persistent infections with high reproducibility and minimal variation in regard to wound complications. Moreover, it has been reported that approximately 50% of combat wounds become clinically infected ([ 1 9 10 5 CFU) as opposed to merely contaminated [2,28]. Notably, as a limitation in identifying the presence of all persistent microorganisms, only aerobic wound microflora were cultured from soft tissue and bone marrow.…”

Section: Discussionmentioning

confidence: 99%

Bioburden Increases Heterotopic Ossification Formation in an Established Rat Model

Pavey

Qureshi

Hope

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Heterotopic ossification (HO) develops in a majority of combat-related amputations wherein early bacterial colonization has been considered a potential early risk factor. Our group has recently developed a small animal model of trauma-induced HO that incorporates many of the multifaceted injury patterns of combat trauma in the absence of bacterial contamination and subsequent wound colonization. Questions/purposes We sought to determine if (1) the presence of bioburden (Acinetobacter baumannii and methicillin-resistant Staphylococcus aureus [MRSA]) increases the magnitude of ectopic bone formation in traumatized muscle after amputation; and (2) what persistent effects bacterial contamination has on late microbial flora within the amputation site. Methods Using a blast-related HO model, we exposed 48 rats to blast overpressure, femur fracture, crush injury, and subsequent immediate transfemoral amputation through the zone of injury. Control injured rats (n = 8) were inoculated beneath the myodesis with phosphate-buffered saline not containing bacteria (vehicle) and treatment rats were inoculated with 1 9 10 6 colony-forming units of A baumannii (n = 20) or MRSA (n = 20). All animals formed HO. Heterotopic ossification was determined by quantitative volumetric measurements of ectopic bone at 12-weeks postinjury using micro-CT and qualitative histomorphometry for assessment of new bone formation in the residual limb. Bone marrow and muscle tissue biopsies The authors are employees of the US Government. This work was prepared as part of their official duties. Title 17 USC §105 provides that ''Copyright protection under this title is not available for any work of the US Government.'' Title 17 USC §101 defined a US Government work as a work prepared by a military service member or employees of the US Government as part of that person's official duties. The opinions or assertions contained in this paper are the private views of the authors and are not to be construed as reflecting the views, policy or positions of the Departments of the Navy, Department of Defense nor the US Government. Each author certifies that his or her institution approved the animal protocol for this investigation and that all investigations were conducted in conformity with ethical principles of research. This work was performed at the Naval Medical Research Center, Silver Spring, MD, USA. were collected from the residual limb at 12 weeks to quantitatively measure the bioburden load and to qualitatively determine the species-level identification of the bacterial flora. Results At 12 weeks, we observed a greater volume of HO in rats infected with MRSA (68.9 ± 8.6 mm 3 ; 95% confidence interval [CI], 50.52-85.55) when compared with A baumannii (20.9 ± 3.7 mm 3

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Section: Discussionmentioning

confidence: 99%

Bioburden Increases Heterotopic Ossification Formation in an Established Rat Model

Pavey

Qureshi

Hope

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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“…A. baumannii can cause severe community-acquired pneumonia occurring mainly during the warm and humid months in tropical and subtropical zones (10,11). In addition, A. baumannii isolates have been recovered from wounds of survivors of natural disasters (12,13), as well as from soldiers (14) and civilians (15) during warfare. Reports studying A. baumannii human carriage in the community are rare, and the prevalence has varied according to the countries and the identification methods used, from 0.5% to 3% in Europe (16)(17)(18), 4% in Hong Kong (19), and 5.4% in Senegal (20) to 10.4% in the United States (21).…”

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confidence: 99%

Extrahuman Epidemiology of Acinetobacter baumannii in Lebanon

Rafei

Hamzé

Pailhoriès

et al. 2015

Appl Environ Microbiol

113

101

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The presence of Acinetobacter baumannii outside hospitals is still a controversial issue. The objective of our study was to explore the extrahospital epidemiology of A. baumannii in Lebanon. From February 2012 to October 2013, a total of 73 water samples, 51 soil samples, 37 raw cow milk samples, 50 cow meat samples, 7 raw cheese samples, and 379 animal samples were analyzed by cultural methods for the presence of A. baumannii. Species identification was performed by rpoB gene sequencing. Antibiotic susceptibility was investigated, and the A. baumannii population was studied by two genotyping approaches: multilocus sequence typing (MLST) and bla OXA-51 sequence-based typing (SBT). A. baumannii was detected in 6.9% of water samples, 2.7% of milk samples, 8.0% of meat samples, 14.3% of cheese samples, and 7.7% of animal samples. All isolates showed a susceptible phenotype against most of the antibiotics tested and lacked carbapenemase-encoding genes, except one that harbored a bla OXA-143 gene. MLST analysis revealed the presence of 36 sequence types (STs), among which 24 were novel STs reported for the first time in this study. bla OXA-51 SBT showed the presence of 34 variants, among which 21 were novel and all were isolated from animal origins. Finally, 30 isolates had new partial rpoB sequences and were considered putative new Acinetobacter species. In conclusion, animals can be a potential reservoir for A. baumannii and the dissemination of new emerging carbapenemases. The roles of the novel animal clones identified in community-acquired infections should be investigated.

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“…Despite significant advancements in wound and burn care, wound infections caused by MDR bacteria, including A. baumannii, still remain a major problem with regard to morbidity and mortality in both civilians and wounded military service members (1,2,6,7,8). Wound infections occur at higher rates among military service members, possibly due to issues associated with the type of traumatic injury, time until treatment, and the fact that the patients will pass through multiple medical facilities before arriving at a U.S. treatment facility (7).…”

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Validation of a Novel Murine Wound Model of Acinetobacter baumannii Infection

Thompson

Black

Pavlicek

et al. 2014

Antimicrob Agents Chemother

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e Patients recovering from traumatic injuries or surgery often require weeks to months of hospitalization, increasing the risk for wound and surgical site infections caused by ESKAPE pathogens, which include A. baumannii (the ESKAPE pathogens are Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species). As new therapies are being developed to counter A. baumannii infections, animal models are also needed to evaluate potential treatments. Here, we present an excisional, murine wound model in which a diminutive inoculum of a clinically relevant, multidrug-resistant A. baumannii isolate can proliferate, form biofilms, and be effectively treated with antibiotics. The model requires a temporary, cyclophosphamide-induced neutropenia to establish an infection that can persist. A 6-mmdiameter, full-thickness wound was created in the skin overlying the thoracic spine, and after the wound bed was inoculated, it was covered with a dressing for 7 days. Uninoculated control wounds healed within 13 days, whereas infected, placebo-treated wounds remained unclosed beyond 21 days. Treated and untreated wounds were assessed with multiple quantitative and qualitative techniques that included gross pathology, weight loss and recovery, wound closure, bacterial burden, 16S rRNA community profiling, histopathology, peptide nucleic acid-fluorescence in situ hybridization, and scanning electron microscopy assessment of biofilms. The range of differences that we are able to identify with these measures in antibiotic-versus placebo-treated animals provides a clear window within which novel antimicrobial therapies can be assessed. The model can be used to evaluate antimicrobials for their ability to reduce specific pathogen loads in wounded tissues and clear biofilms. Ultimately, the mouse model approach allows for highly powered studies and serves as an initial multifaceted in vivo assessment prior to testing in larger animals.

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The majority of US combat casualty soft-tissue wounds are not infected or colonized upon arrival or during treatment at a continental US military medical facility

Cited by 67 publications

References 8 publications

Bioburden Increases Heterotopic Ossification Formation in an Established Rat Model

Bioburden Increases Heterotopic Ossification Formation in an Established Rat Model

Extrahuman Epidemiology of Acinetobacter baumannii in Lebanon

Validation of a Novel Murine Wound Model of Acinetobacter baumannii Infection

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