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

Abstract

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.

Spectrum of antibiotic resistant bacteria and fungi isolated from chronically infected wounds in a rural district hospital in Ghana

“…The estimation of their clinical relevance is much more difficult even though it is generally accepted that Enterobacteriaceae like E. coli and others might play a role in wound infections [17,20]. Inhabitants of tropical or subtropical climate zones were shown to have high colonization rates of skin and mucous membranes with Gram-negative rod-shaped bacteria [21]. High frequencies were also reported from patients, students, and health-care workers in Madagascar [22].…”

Screening for carbapenemases in ertapenem-resistant Enterobacteriaceae collected at a Tunisian hospital between 2014 and 2018

“…During an assessment at a hospital in Tunis for about 3 months in 2014, 19 Gram-negative strains with resistance against 3rd generation cephalosporins were isolated from rectal swabs of 14 out of 31 patients (45.2%), one week after admission to hospital. Of note, rectal swabs of the same patients had been negative at the time of admission, indicating either nosocomial transmission as suggested by the authors of the study [25] or, alternatively, selection under the selective pressure of antibiotic treatment [26]. Identified ESBL genes comprised bla CTX-M-14 , bla CTX-M-15 , and bla GES-2 , while also carbapenemase genes, namely, bla GES-11 , bla NDM-1 , bla OXA-23 , and bla OXA-48 were identified [25].…”

Spectrum of antibiotic resistant bacteria and fungi isolated from chronically infected wounds in a rural district hospital in Ghana

“…inhabitants of tropical or subtropical climate zones were shown to have high colonization rates of skin and mucous membranes with Gram-negative rod-shaped bacteria [20]. High frequencies were also reported from patients, students, and health-care workers in Madagascar [21].…”