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Karp MC, April MD, Newberry RK, Schauer SG. Associations with Prehospital Antibiotic Receipt among Combat Casualties with Open Wounds: A Department of Defense Trauma Registry Study. Mil Med 2024; 189:e606-e611. [PMID: 37647617 DOI: 10.1093/milmed/usad323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 07/24/2023] [Accepted: 08/03/2023] [Indexed: 09/01/2023] Open
Abstract
INTRODUCTION Current Tactical Combat Casualty Care (TCCC) guidelines recommend antibiotic administration for all open wounds to prevent infection. We identified associations between demographics, procedures, and medicines with the receipt of prehospital antibiotics among combat casualties. MATERIALS AND METHODS We used a series of emergency department procedure codes to identify adult subjects within the Department of Defense Trauma Registry from January 2007 to August 2016 who sustained open wounds. We compared demographics, procedures, and medicines administered among casualties receiving prehospital wound prophylaxis versus casualties not receiving antibiotic prophylaxis. We controlled for confounders with multivariable logistical regression. RESULTS We identified 18,366 encounters meeting inclusion criteria. Antibiotic recipients (n = 2384) were comparable to nonrecipients (n = 15,982) with regard to age and sex. Antibiotic recipients were more likely to sustain injuries from firearms and undergo all procedures examined related to hemorrhage control, airway management, pneumothorax treatment, and volume replacement except for intraosseous access. Antibiotic recipients were less likely to sustain injuries from explosives. Antibiotic recipients had a modestly higher survival than nonrecipients (97.4% versus 96.0%). Associations with prehospital antibiotic receipt in multivariable logistic regression included non-North Atlantic Treaty Organization military force affiliation (odds ratio (OR) 4.65, 95% CI, 1.0-20.8), tachycardia (OR 3.4, 95% CI, 1.1-10.5), intubation (OR 2.0, 95% CI, 1.1-3.8), and administration of tranexamic acid (OR 5.6, 95% CI, 1.2-26.5). CONCLUSIONS The proportion of combat casualties with open wounds receiving prehospital antibiotics was low despite published recommendations for early antibiotics in patients with open wounds. These findings highlight the ongoing need for additional educational and quality assurance initiatives to continue improving adherence to TCCC guidelines with regard to prehospital antibiotic administration. Future studies are necessary to determine reasons for suboptimal TCCC guideline compliance.
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Affiliation(s)
- Marissa C Karp
- Adjutant General Captains Career Course, Fort Jackson, SC 29207, USA
| | - Michael D April
- 14th Field Hospital, Fort Stewart, GA, USA
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Ryan K Newberry
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Steven G Schauer
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Departments of Anesthesiology and Emergency Medicine, University of Colorado School of Medicine, Aurora, Colorado 80045, USA
- Center for Combat and Battlefield (COMBAT) Research, University of Colorado School of Medicine, Aurora, Colorado 80045, USA
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Rapid, label-free pathogen identification system for multidrug-resistant bacterial wound infection detection on military members in the battlefield. PLoS One 2022; 17:e0267945. [PMID: 35511776 PMCID: PMC9070933 DOI: 10.1371/journal.pone.0267945] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/19/2022] [Indexed: 12/24/2022] Open
Abstract
US military service members experiencing combat-related wounds have higher risk of infection by multidrug-resistant bacteria. The gold standard culture-based antimicrobial susceptibility testing (AST) is not feasible in the battlefield environment. Thus, a rapid deployable system for bacteria identification and AST directly from wound sample is urgently needed. We report the potential of a Rapid, Label-free Pathogen Identification (RAPID) diagnostic system based on ATR-FTIR method to detect and distinguish multi-drug resistant strains for six different species in the ESKAPEE group. Our RAPID system combines sample processing on-broad to isolate and enrich bacteria cells from wound sample, ATR-FTIR measurement to detect antimicrobial-induced bacterial cell spectral changes, and machine learning model for automated, objective, and quantitative spectral analysis and unknown sample classification. Based on experimental results, our RAPID system is a promising technology for label-free, sensitive (104 cfu/mL from mixture), species-specific (> 95% accuracy), rapid (< 10 min for identification, ~ 4 hours for AST) bacteria detection directly from wound samples.
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Agans RT, Giles GE, Goodson MS, Karl JP, Leyh S, Mumy KL, Racicot K, Soares JW. Evaluation of Probiotics for Warfighter Health and Performance. Front Nutr 2020; 7:70. [PMID: 32582752 PMCID: PMC7296105 DOI: 10.3389/fnut.2020.00070] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 04/24/2020] [Indexed: 12/12/2022] Open
Abstract
The probiotic industry continues to grow in both usage and the diversity of products available. Scientific evidence supports clinical use of some probiotic strains for certain gastrointestinal indications. Although much less is known about the impact of probiotics in healthy populations, there is increasing consumer and scientific interest in using probiotics to promote physical and psychological health and performance. Military men and women are a unique healthy population that must maintain physical and psychological health in order to ensure mission success. In this narrative review, we examine the evidence regarding probiotics and candidate probiotics for physical and/or cognitive benefits in healthy adults within the context of potential applications for military personnel. The reviewed evidence suggests potential for certain strains to induce biophysiological changes that may offer physical and/or cognitive health and performance benefits in military populations. However, many knowledge gaps exist, effects on health and performance are generally not widespread among the strains examined, and beneficial findings are generally limited to single studies with small sample sizes. Multiple studies with the same strains and using similar endpoints are needed before definitive recommendations for use can be made. We conclude that, at present, there is not compelling scientific evidence to support the use of any particular probiotic(s) to promote physical or psychological performance in healthy military personnel. However, plausibility for physical and psychological health and performance benefits remains, and additional research is warranted. In particular, research in military cohorts would aid in assessing the value of probiotics for supporting physical and psychological health and performance under the unique demands required of these populations.
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Affiliation(s)
- Richard T Agans
- Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, MD, United States.,Naval Medical Research Unit Dayton, Environmental Health Effects Laboratory, Dayton, OH, United States
| | - Grace E Giles
- Soldier Performance Optimization Directorate, U.S. Army Combat Capabilities Development Command - Soldier Center, Natick, MA, United States
| | - Michael S Goodson
- Air Force Research Laboratory, 711th Human Performance Wing, Wright Patterson Air Force Base, Dayton, OH, United States
| | - J Philip Karl
- Military Nutrition Division, U.S. Army Research Institute of Environmental Medicine, Natick, MA, United States
| | - Samantha Leyh
- Air Force Research Laboratory, 711th Human Performance Wing, Wright Patterson Air Force Base, Dayton, OH, United States.,Oak Ridge Institute for Science and Education, Wright Patterson Air Force Base, Oak Ridge, TN, United States
| | - Karen L Mumy
- Naval Medical Research Unit Dayton, Environmental Health Effects Laboratory, Dayton, OH, United States
| | - Kenneth Racicot
- Soldier Performance Optimization Directorate, U.S. Army Combat Capabilities Development Command - Soldier Center, Natick, MA, United States
| | - Jason W Soares
- Soldier Performance Optimization Directorate, U.S. Army Combat Capabilities Development Command - Soldier Center, Natick, MA, United States
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Pinto AM, Cerqueira MA, Bañobre-Lópes M, Pastrana LM, Sillankorva S. Bacteriophages for Chronic Wound Treatment: from Traditional to Novel Delivery Systems. Viruses 2020; 12:E235. [PMID: 32093349 PMCID: PMC7077204 DOI: 10.3390/v12020235] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 02/14/2020] [Accepted: 02/18/2020] [Indexed: 12/14/2022] Open
Abstract
The treatment and management of chronic wounds presents a massive financial burden for global health care systems, with significant and disturbing consequences for the patients affected. These wounds remain challenging to treat, reduce the patients' life quality, and are responsible for a high percentage of limb amputations and many premature deaths. The presence of bacterial biofilms hampers chronic wound therapy due to the high tolerance of biofilm cells to many first- and second-line antibiotics. Due to the appearance of antibiotic-resistant and multidrug-resistant pathogens in these types of wounds, the research for alternative and complementary therapeutic approaches has increased. Bacteriophage (phage) therapy, discovered in the early 1900s, has been revived in the last few decades due to its antibacterial efficacy against antibiotic-resistant clinical isolates. Its use in the treatment of non-healing wounds has shown promising outcomes. In this review, we focus on the societal problems of chronic wounds, describe both the history and ongoing clinical trials of chronic wound-related treatments, and also outline experiments carried out for efficacy evaluation with different phage-host systems using in vitro, ex vivo, and in vivo animal models. We also describe the modern and most recent delivery systems developed for the incorporation of phages for species-targeted antibacterial control while protecting them upon exposure to harsh conditions, increasing the shelf life and facilitating storage of phage-based products. In this review, we also highlight the advances in phage therapy regulation.
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Affiliation(s)
- Ana M. Pinto
- INL—International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga, 4715-330 Braga, Portugal; (A.M.P.); (M.A.C.); (M.B.-L.); (L.M.P.)
- CEB—Centre of Biological Engineering, LIBRO—Laboratório de Investigação em Biofilmes Rosário Oliveira, University of Minho, Campus de Gualtar, 4710-057 Braga, Portugal
| | - Miguel A. Cerqueira
- INL—International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga, 4715-330 Braga, Portugal; (A.M.P.); (M.A.C.); (M.B.-L.); (L.M.P.)
| | - Manuel Bañobre-Lópes
- INL—International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga, 4715-330 Braga, Portugal; (A.M.P.); (M.A.C.); (M.B.-L.); (L.M.P.)
| | - Lorenzo M. Pastrana
- INL—International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga, 4715-330 Braga, Portugal; (A.M.P.); (M.A.C.); (M.B.-L.); (L.M.P.)
| | - Sanna Sillankorva
- INL—International Iberian Nanotechnology Laboratory, Av. Mestre José Veiga, 4715-330 Braga, Portugal; (A.M.P.); (M.A.C.); (M.B.-L.); (L.M.P.)
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Glick Y, Furer A, Glick K, Yitzhak A, Brosh T. The Israeli Defense Forces Point of Injury Antimicrobial Treatment Protocol - A New Protocol and Review of the Literature. Mil Med 2019; 184:78-82. [PMID: 30901438 DOI: 10.1093/milmed/usy292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/26/2018] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Combat wound infection is a common and serious complication, leading to significant morbidity and mortality. In 2005, a point of injury antimicrobial protocol was published by the Israel Defense Forces, in which Moxifloxacin was chosen. During 2016-2017, a revision of this protocol was performed and concluded with the publication of an updated protocol. The purpose of this report is to present this process and the revised protocol, together with a review of the literature. METHODS We searched "Medline" and "Google Scholar" for studies dealing with antimicrobial prophylaxis in trauma, for militaries' point of injury antimicrobial protocol protocols and for established surgical antimicrobial prophylaxis protocols. RESULTS Point of injury antimicrobial protocol is aimed at preventing early infection and its complications. The choice of Moxifloxacin for this purpose may not be optimal since Moxifloxacin spectrum might be overly broad, there is scant evidence supporting it for this indication, and the available preparation does not meet distinctive technical requirements. Contrarily, Ceftriaxone seemed to have suitable microbiological, pharmacological and technical features. CONCLUSION Point of injury antimicrobial protocol should be used especially when evacuation and definitive surgical treatment are delayed. According to present scientific data and operational needs, Ceftriaxone was chosen for most penetrating injuries, with Metronidazole addition for penetrating abdominal and cranial trauma.
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Affiliation(s)
- Yuval Glick
- Israel Defense Forces Medical Corps, Surgeon General's Headquarters, Military POB 02149 Tel Hashomer, Ramat Gan, Military Postal Code, Israel
| | - Ariel Furer
- Israel Defense Forces Medical Corps, Surgeon General's Headquarters, Military POB 02149 Tel Hashomer, Ramat Gan, Military Postal Code, Israel
| | - Karina Glick
- Internal Medicine Department "A', Assuta Ashdod University Hospital, 7 Ha-Refua St., Ashdod, Israel
| | - Avraham Yitzhak
- Israel Defense Forces Medical Corps, Surgeon General's Headquarters, Military POB 02149 Tel Hashomer, Ramat Gan, Military Postal Code, Israel
| | - Tal Brosh
- Israel Defense Forces Medical Corps, Surgeon General's Headquarters, Military POB 02149 Tel Hashomer, Ramat Gan, Military Postal Code, Israel.,Faculty of Health Sciences, Ben-Gurion University of the Negev, Ben-Gurion Blvd., Be'er-Sheva, Israel.,Infectious Diseases Unit, Assuta Ashdod University Hospital, 7 Ha-Refua St., Ashdod, Israel
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Grosset A, Mangin P, MacNab C, Pfister G, de l'Escalopier N, Cournac JM, Aletti M, Samson T, Rigal S, Mathieu L. Input of a Multi-Disciplinary Meeting in the Treatment of Osteoarticular Infections in French War Casualties. Mil Med 2019; 184:e359-e364. [PMID: 30535350 DOI: 10.1093/milmed/usy369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Revised: 07/02/2018] [Accepted: 11/14/2018] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Extremity war-wounds present an elevated risk of infection and compromise reconstructive procedures. In a French military hospital, a multi-disciplinary meeting (MDM) was created to standardize the care given to soldiers with osteoarticular infection. The aim of this study was to evaluate the usefulness of MDM decisions. METHODS An observational case study was performed including the French wounded at war treated for an osteoarticular infection between 2004 and 2016. They were separated into two groups according to their time of management: before (group A) or after (group B) the MDM creation in September 2010. Various operative and bacteriological parameters were analyzed retrospectively. A questionnaire was created to evaluate healthcare professionals' satisfaction toward the usefulness of the MDM on their practice. RESULTS During the study period, 38 patients were included: 19 in group A and 19 in group B. Initial tests found an infection with one pathogen in 15 patients, an infection with 2 pathogens in 11 patients, and an infection with 3 or more pathogens in 12 patients. Enterobacter cloacae was the most common pathogen. Pseudomonas aeruginosa and Escherichia coli were also frequent. The mean number of samples taken to conduct the bacteriological tests per operating session was significantly higher for group B than for group A. Twelve of the 14 questioned healthcare professionals believed the MDM was very useful in their patient management. CONCLUSION The MDM seems to have had a beneficial impact on orthopedic surgeon practices. A significant increase of the number of samples taken was the most obvious sign that the French recommended practices for osteoarticular infections were followed since the creation of MDM.
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Affiliation(s)
- Antoine Grosset
- Department of Orthopedic, Traumatology and Reconstructive Surgery and Trauma, PERCY Military Teaching Hospital, 101 Avenue Henri Barbusse, Clamart, France
| | - Philippe Mangin
- Department of Orthopedic, Traumatology and Reconstructive Surgery and Trauma, PERCY Military Teaching Hospital, 101 Avenue Henri Barbusse, Clamart, France
| | - Christine MacNab
- Department of Microbiology, PERCY Military Teaching Hospital, 101 Avenue Henri Barbusse, Clamart, France
| | - Georges Pfister
- Department of Orthopedic, Traumatology and Reconstructive Surgery and Trauma, PERCY Military Teaching Hospital, 101 Avenue Henri Barbusse, Clamart, France
| | - Nicolas de l'Escalopier
- Department of Orthopedic, Traumatology and Reconstructive Surgery and Trauma, PERCY Military Teaching Hospital, 101 Avenue Henri Barbusse, Clamart, France
| | - Jean-Marie Cournac
- Department of Internal Medicine, Infectious Disease, PERCY Military Teaching Hospital, 101 Avenue Henri Barbusse, Clamart, France
| | - Marc Aletti
- Department of Internal Medicine, Infectious Disease, PERCY Military Teaching Hospital, 101 Avenue Henri Barbusse, Clamart, France
| | - Thierry Samson
- Department of Microbiology, PERCY Military Teaching Hospital, 101 Avenue Henri Barbusse, Clamart, France
| | - Sylvain Rigal
- Department of Orthopedic, Traumatology and Reconstructive Surgery and Trauma, PERCY Military Teaching Hospital, 101 Avenue Henri Barbusse, Clamart, France
| | - Laurent Mathieu
- Department of Orthopedic, Traumatology and Reconstructive Surgery and Trauma, PERCY Military Teaching Hospital, 101 Avenue Henri Barbusse, Clamart, France
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Lundin JG, McGann CL, Weise NK, Estrella LA, Balow RB, Streifel BC, Wynne JH. Iodine binding and release from antimicrobial hemostatic polymer foams. REACT FUNCT POLYM 2019. [DOI: 10.1016/j.reactfunctpolym.2018.12.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Rogers E, Wright C. For debate: on-the-person battlefield antibiotics. BMJ Mil Health 2018; 166:175-178. [PMID: 30530792 DOI: 10.1136/jramc-2018-001033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/19/2018] [Accepted: 11/21/2018] [Indexed: 11/04/2022]
Abstract
Wound infection has always been an important contributor to mortality and morbidity on the battlefield. On-the-person antibiotics have long been suggested as one way to help combat this, which have already been implemented by some North Atlantic Treaty Organization partners. This paper is an up-to-date review of the evidence of the efficacy of on-the-person antibiotics and whether the British military should look to use them in the near future.
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Affiliation(s)
- Edward Rogers
- Army Medical Services Support Unit, Robertson House, RMAS, Camberly, UK .,Department of Anaesthesia, Frimley Park NHS Foundation Trust, Frimley, UK
| | - C Wright
- Emergency Department, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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