Osteomyelitis in Military Personnel Wounded in Iraq and Afghanistan

Yun, Heather C.; Branstetter, Joanna G.; Murray, Clinton K.

doi:10.1097/ta.0b013e318160868c

Cited by 125 publications

(100 citation statements)

References 23 publications

(10 reference statements)

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“…The literature supports a limited role for A. baumannii in clinical osteomyelitis [8,17,20,21]. In one study, clinical improvement of osteomyelitis, including MDR AB, occurred without recurrence in 18 of 18 patients after a mean of 9 months, often despite the presence of internal stabilization and lack of extended continuation therapy with oral antibiotics.…”

Section: Discussionmentioning

confidence: 96%

“…These findings were attributed to expert débridement, 6 weeks of directed antibiotics, and to the general good health of the patients [8]. Another study revealed Gram-negative rods like A. baumannii were widely present in first episodes of osteomyelitis but more rarely present in recurrences or treatment failures despite drug resistance and orthopaedic devices [21]. In two case reports of patients with A. baumannii, osteomyelitis resolved uneventfully with débridement and 6 weeks of antibiotics [17,20].…”

Section: Discussionmentioning

confidence: 99%

“…A retrospective chart review concluded that initial episodes of combat-related osteomyelitis from the upper and lower extremities were more likely to be polymicrobial than monomicrobial. A. baumannii was more likely to be recovered during original episodes of osteomyelitis than during recurrences, whereas SA was more likely to be isolated during recurrences than during the initial episode of osteomyelitis [21]. Another retrospective chart review again highlighted the polymicrobial nature of combat-related osteomyelitis, but found Gram-negative rods like A. baumannii were more common than Gram-positive organisms such as SA during early and late infections [14].…”

Section: Discussionmentioning

confidence: 99%

“…However, several studies suggest infections with this organism may be easier to control in combat-related osteomyelitis [8,17,20,21].…”

Section: Introductionmentioning

confidence: 99%

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Acinetobacter baumannii is not Associated with Osteomyelitis in a Rat Model: A Pilot Study

Collinet-Adler¹,

Castro²,

Ledonio³

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background Multidrug resistant Acinetobacter baumannii (MDR AB) with and without Staphylococcus aureus (SA) is a commonly isolated organism in infected segmental bone defects in combat-related trauma in Iraq and Afghanistan. Although MDR AB in visceral infections is a therapeutic challenge, control of infection appears more common for combat-related osteomyelitis.Questions/purposes Using a rat model, we explored the virulence of MDR AB in segmental bone defects alone and in combination with SA. Methods Segmental defects in 60 rat femurs were created, stabilized, and inoculated with MDR AB alone and 60 with MDR AB and SA. We performed qualitative and quantitative bacteriology and radiographic assessments at 2, 4, and 8 weeks for MDR AB and at 1, 2, and 3 weeks for MDR AB and SA. Results Quantitative bacteriology revealed a 3-to 5-log decrease in MDR AB from the initial inoculum. After polymicrobial inoculation, only 10 of 60 animals had positive cultures for MDR AB, whereas 59 of 60 animals had positive cultures for SA. Recovered SA were 2 to 5 log greater than the initial inoculum, while there again was a 3-to 5-log decrease in MDR AB. MDR AB alone did not cause bony lysis, but there was radiographic evidence of new bone formation in 67% of the segmental defects. Osteolysis was noted with MDR AB and SA. Conclusions MDR AB did not appear to cause or contribute to clinically apparent osteomyelitis in this pilot study. Clinical Relevance Resolution of infections in combatrelated segmental bone defects inoculated with MDR AB may be attributable to low virulence.

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“…However, several studies suggest infections with this organism may be easier to control in combat-related osteomyelitis [8,17,20,21].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Acinetobacter baumannii is not Associated with Osteomyelitis in a Rat Model: A Pilot Study

Collinet-Adler¹,

Castro²,

Ledonio³

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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“…Military work has suggested that there may be a beneficial effect in an infected segmental rat femur defect model [130], but quality clinical data is lacking. Osteomyelitis with challenging MDR organisms is likely to become increasingly important in the future [131] and a concern for home nation health providers. This is an area in which basic research is required, supported by subsequent quality clinical analysis of the treatment strategies for complex limb trauma.…”

Section: Infection In Conflict Wounded-future Directions In Research mentioning

confidence: 99%

Infection in conflict wounded

Eardley

Brown

Bonner

et al. 2011

Phil. Trans. R. Soc. B

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Although mechanisms of modern military wounding may be distinct from those of ancient conflicts, the infectious sequelae of ballistic trauma and the evolving microbial flora of war wounds remain a considerable burden on both the injured combatant and their deployed medical systems. Battlefield surgeons of ancient times favoured suppuration in war wounding and as such Galenic encouragement of pus formation would hinder progress in wound care for centuries. Napoleonic surgeons eventually abandoned this mantra, embracing radical surgical intervention, primarily by amputation, to prevent infection. Later, microscopy enabled identification of microorganisms and characterization of wound flora. Concurrent advances in sanitation and evacuation enabled improved outcomes and establishment of modern military medical systems. Advances in medical doctrine and technology afford those injured in current conflicts with increasing survivability through rapid evacuation, sophisticated resuscitation and timely surgical intervention. Infectious complications in those that do survive, however, are a major concern. Addressing antibiotic use, nosocomial transmission and infectious sequelae are a current clinical management and research priority and will remain so in an era characterized by a massive burden of combat extremity injury. This paper provides a review of infection in combat wounding from a historical setting through to the modern evidence base.

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