Lessons of war

Blyth, Dana M; Yun, Heather C.; Tribble, David R.; Murray, Clinton K.

doi:10.1097/ta.0000000000000768

Cited by 51 publications

(19 citation statements)

References 91 publications

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“…High rates of multidrug resistance, in particular among Gram-negative organisms, were reported from war injuries during the recent conflicts in Iraq and Afghanistan [ 26 ]. In a recent point prevalence assessment from the European Union Training Mission in Mali (EUTM MLI), an enteric colonization rate of 27.1% (13 / 48) ESBL-positive Enterobacteriaceae could be demonstrated for European soldiers with traveler's diarrhea [ 27 , 28 ].…”

Section: Experience From Military Medical Facilities In Theatermentioning

confidence: 99%

Resistant Gram-Negative Bacteria and Diagnostic Point-of-Care Options for the Field Setting during Military Operations

Frickmann

Podbielski²,

Kreikemeyer³

2018

BioMed Research International

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The spread of multidrug-resistant bacteria in resource-poor settings affects the military medical service in case of deployments of soldiers to war and crisis zones. Patients with war injuries are prone to colonization or infection with multidrug-resistant bacteria. Resistant Gram-negative bacteria play a dominant role in military wound infections. Problematic hygiene conditions on deployment facilitate exposition of soldiers with subsequent colonization. Although colonizing strains are frequently cleared from their hosts after returning from deployment, transmission to close contacts of the soldiers in the home country cannot be excluded and therapeutic options are reduced if colonization progresses to invasive infection. Since sophisticated culture-based diagnostic approaches are typically not available in the field setting on deployment, molecular rapid diagnostic test systems are an option for transmission control if the locally prevalent molecular resistance mechanisms are known. Efforts for global resistance surveillance can contribute to better understanding of resistance distribution and spread at deployment sites. This review summarizes experience of the military medical services with multidrug resistance on deployment and with the influx of resistant strains to the home country and discusses potential use of available molecular rapid test systems as an option for the field setting.

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Section: Experience From Military Medical Facilities In Theatermentioning

confidence: 99%

Resistant Gram-Negative Bacteria and Diagnostic Point-of-Care Options for the Field Setting during Military Operations

Frickmann

Podbielski²,

Kreikemeyer³

2018

BioMed Research International

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“…Worldwide, armed conflicts are a major contributor to the global burden of disease [ 1 ]. Conflict-related injuries often result in soft tissue and bone being contaminated with foreign material, leading to infection [ 2 , 3 ]. The cornerstones of war wound management are surgical intervention and antibiotic therapy.…”

Section: Introductionmentioning

confidence: 99%

Infection with high proportion of multidrug-resistant bacteria in conflict-related injuries is associated with poor outcomes and excess resource consumption: a cohort study of Syrian patients treated in Jordan

et al. 2018

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BackgroundArmed conflicts are a major contributor to injury and death globally. Conflict-related injuries are associated with a high risk of wound infection, but it is unknown to what extent infection directly relates to sustainment of life and restoration of function. The aim of this study was to investigate the outcome and resource consumption among civilians receiving acute surgical treatment due to conflict-related injuries. Patients with and without wound infections were compared.MethodsWe performed a cohort study using routinely collected data from 457 consecutive Syrian civilians that received surgical treatment for acute conflict-related injuries during 2014–2016 at a Jordanian hospital supported by Médecins Sans Frontières. We defined wound infection as clinical signs of infection verified by a positive culture. We used logistic regression models to evaluate infection-related differences in outcome and resource consumption.ResultsWound infection was verified in 49/457 (11%) patients. Multidrug-resistance (MDR) was detected in 36/49 (73%) of patients with infection. Among patients with infection, 11/49 (22%) were amputated, compared to 37/408 (9%) without infection, crude relative risk = 2.62 (95% confidence interval 1.42–4.81). Infected patients needed 12 surgeries on average, compared to five in non-infected patients (p < .00001). Mean length of stay was 77 days for patients with infection, and 35 days for patients without infection (p = .000001).ConclusionsAmong Syrian civilians, infected conflict-related wounds had a high prevalence of MDR bacteria. Wound infection was associated with poor outcomes and high resource consumption. These results could guide the development of antibiotic protocols and adaptations of surgical management to improve care for wound infections in conflict-related injuries.Trial registrationClinicalTrials.gov (NCT02744144). Registered April 13, 2016. Retrospectively registered.

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“…Cutaneous invasive fungal infections following traumatic injury can result in 38% mortality [1][2][3]. Treatment of severe infection involves radical surgical debridement and, in some cases, hemipelvectomy or hip disarticulation are required.…”

Section: Discussionmentioning

confidence: 99%

“…Combat-related cutaneous invasive fungal wound infections cause substantial morbidity with mortality ranging from 11% to 38% [1][2][3]. Cutaneous invasive fungal infections are mostly attributed to dismounted complex blast injury (DCBI), where those on foot patrol experience environmental contamination of their blast wounds [4].…”

Section: Introductionmentioning

confidence: 99%

Designed Antimicrobial Peptides Against Trauma-Related Cutaneous Invasive Fungal Wound Infections

Woodburn¹,

Jaynes

Clemens³

2020

JoF

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Cutaneous invasive fungal wound infections after life-threatening dismounted complex blast injury (DCBI) and natural disasters complicate clinical care. These wounds often require aggressive repeated surgical debridement, can result in amputations and hemipelvectomies and have a 38% mortality rate. Given the substantial morbidity associated with cutaneous fungal wound infections, patients at risk need immediate empiric treatment mandating the use of rapidly acting broad-spectrum antimicrobials, acting on both fungi and bacteria, that are also effective against biofilm and can be administered topically. Designed antimicrobial peptides (dAMPs) are engineered analogues of innate antimicrobial peptides which provide the first line of defense against invading pathogens. The antifungal and antibacterial effect and mammalian cytotoxicity of seven innovative dAMPs, created by iterative structural analog revisions and physicochemical and functional testing were investigated. The dAMPs possess broad-spectrum antifungal activity, in addition to being effective against Gram-negative and Gram-positive bacteria, which is crucial as many wounds are polymicrobial and require immediate empiric treatment. Three of the most potent dAMPs—RP504, RP556 and RP557—possess limited mammalian cytotoxicity following 8 h incubation. If these encouraging broad-spectrum antimicrobial and rapid acting results are translated clinically, these novel dAMPs may become a first line empiric topical treatment for traumatic wound injuries.

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Lessons of war

Cited by 51 publications

References 91 publications

Resistant Gram-Negative Bacteria and Diagnostic Point-of-Care Options for the Field Setting during Military Operations

Resistant Gram-Negative Bacteria and Diagnostic Point-of-Care Options for the Field Setting during Military Operations

Infection with high proportion of multidrug-resistant bacteria in conflict-related injuries is associated with poor outcomes and excess resource consumption: a cohort study of Syrian patients treated in Jordan

Designed Antimicrobial Peptides Against Trauma-Related Cutaneous Invasive Fungal Wound Infections

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