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Wallum TE, Yun HC, Rini EA, Carter K, Guymon CH, Akers KS, Tyner SD, White CE, Murray CK. Pathogens present in acute mangled extremities from Afghanistan and subsequent pathogen recovery. Mil Med 2016; 180:97-103. [PMID: 25562864 DOI: 10.7205/milmed-d-14-00301] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Given the changing epidemiology of infecting pathogens in combat casualties, we evaluated bacteria and fungi in acute traumatic wounds from Afghanistan. From January 2013 to February 2014, 14 mangled lower extremities from 10 explosive-device injured casualties were swabbed for culture at Role 3 facilities. Bacteria were recovered from all patients on the date of injury. Pathogens recovered during routine patient care were recorded. The median injury severity score was 29, median initial Role 3/4 blood product support was 32 units, and median evacuation time was 42 minutes to first surgical care. Gram-positive bacteria were found in some wounds but not methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus. Most wounds were colonized with low-virulence, environmental gram-negative bacteria, and not recovered again during therapy, reflecting wound contamination. Only one wound had the same bacteria (E. cloacae) throughout care at the Role 3, 4, and 5 facilities. Three cultures from two patients had multidrug-resistant bacteria (E. cloacae, E. coli), all detected at Role 5 facilities. Molds were not detected at Role 3, whereas one patient had a mold at Role 4 and 5. Mangled lower extremity injuries have a high contamination rate with environmental organisms, which are not typically associated with infections during the course of the patient's care.
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Affiliation(s)
- Timothy E Wallum
- United States Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234
| | - Heather C Yun
- San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234
| | - Elizabeth A Rini
- Landstuhl Regional Medical Center, CMR 402, Box 1559, APO AE 09180, Landstuhl, Germany
| | - Kristina Carter
- Naval Environmental Preventive Medicine Unit 5 San Diego, 3235 Albacore Alley, San Diego, CA 92136
| | - Charles H Guymon
- United States Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234
| | - Kevin S Akers
- United States Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234
| | - Stuart D Tyner
- United States Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234
| | - Christopher E White
- United States Army Institute of Surgical Research, 3698 Chambers Pass, JBSA Fort Sam Houston, TX 78234
| | - Clinton K Murray
- San Antonio Military Medical Center, 3551 Roger Brooke Drive, JBSA Fort Sam Houston, TX 78234
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O'Bryan TA, Rini EA, Okulicz J, Messner O, Ganesan A, Lalani T, Bavaro MF, O'Connell RJ, Agan BK, Landrum ML. HIV viraemia during hepatitis B vaccination shortens the duration of protective antibody levels. HIV Med 2015; 16:161-7. [PMID: 25586899 DOI: 10.1111/hiv.12189] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2014] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Individuals with HIV infection often have early waning of protective antibody following hepatitis B virus (HBV) vaccination. HIV viraemia at the time of vaccination may limit the durability of serum anti-HBV surface antibody (HBsAb) levels. We investigated the relationship of HIV plasma viral load (VL) and duration of HBsAb among vaccinees enrolled in the US Military HIV Natural History Study. METHODS We included in the study participants who had no history of prior HBV infection, who had received all HBV vaccine doses after HIV diagnosis, and who had demonstrated an initial vaccine response, defined as HBsAb ≥ 10 IU/L. Responders were retrospectively followed with serial HBV serology from the time of the last vaccine dose until the development of waning (HBsAb < 10 IU/L) or the last HBsAb measurement. Time to and risk for waning were evaluated with Kaplan-Meier survival methods and Cox proportional hazards models, respectively. RESULTS A total of 186 initial vaccine responders were identified. During 570 person-years of observation, HBsAb waned in 52 of 186 participants (28%). The cumulative proportion maintaining HBsAb ≥ 10 IU/L was 83% at 2 years and 56% at 5 years. Participants with an undetectable VL [hazard ratio (HR) 0.37; 95% confidence interval (CI) 0.18-0.76] or with detectable VL of ≤ 10 000 copies/mL (HR 0.46; 95% CI 0.21-1.00) had reduced risk of waning. Other factors including age, number of vaccine doses, CD4 count, and receipt of highly active antiretroviral therapy (HAART) were not significantly associated with risk of waning HBsAb. CONCLUSIONS Undetectable or low HIV VL at the time of HBV vaccination is associated with greater durability of vaccine response in patients with HIV infection.
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Affiliation(s)
- T A O'Bryan
- Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, MD, USA; San Antonio Military Medical Center, Fort Sam Houston, TX, USA
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Rini EA, Weintrob AC, Tribble DR, Lloyd BA, Warkentien TE, Shaikh F, Li P, Aggarwal D, Carson ML, Murray CK. Compliance with antimalarial chemoprophylaxis recommendations for wounded United States military personnel admitted to a military treatment facility. Am J Trop Med Hyg 2014; 90:1113-6. [PMID: 24732457 PMCID: PMC4047738 DOI: 10.4269/ajtmh.13-0646] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Accepted: 03/13/2014] [Indexed: 11/07/2022] Open
Abstract
Malaria chemoprophylaxis is used as a preventive measure in military personnel deployed to malaria-endemic countries. However, limited information is available on compliance with chemoprophylaxis among trauma patients during hospitalization and after discharge. Therefore, we assessed antimalarial primary chemoprophylaxis and presumptive antirelapse therapy (primaquine) compliance among wounded United States military personnel after medical evacuation from Afghanistan (June 2009-August 2011) to Landstuhl Regional Medical Center in Landstuhl, Germany, and then to three U.S. military hospitals. Among admissions at Landstuhl Regional Medical Center, 74% of 2,540 patients were prescribed primary chemoprophylaxis and < 1% were prescribed primaquine. After transfer of 1,331 patients to U.S. hospitals, 93% received primary chemoprophylaxis and 33% received primaquine. Of 751 trauma patients with available post-admission data, 42% received primary chemoprophylaxis for four weeks, 33% received primaquine for 14 days, and 17% received both. These antimalarial chemoprophylaxis prescription rates suggest that improved protocols to continue malaria chemoprophylaxis in accordance with force protection guidelines are needed.
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Affiliation(s)
- Elizabeth A Rini
- Brooke Army Medical Center, Fort Sam Houston, Texas; Walter Reed National Military Medical Center, Bethesda, Maryland; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Amy C Weintrob
- Brooke Army Medical Center, Fort Sam Houston, Texas; Walter Reed National Military Medical Center, Bethesda, Maryland; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Landstuhl Regional Medical Center, Landstuhl, Germany
| | - David R Tribble
- Brooke Army Medical Center, Fort Sam Houston, Texas; Walter Reed National Military Medical Center, Bethesda, Maryland; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Bradley A Lloyd
- Brooke Army Medical Center, Fort Sam Houston, Texas; Walter Reed National Military Medical Center, Bethesda, Maryland; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Tyler E Warkentien
- Brooke Army Medical Center, Fort Sam Houston, Texas; Walter Reed National Military Medical Center, Bethesda, Maryland; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Faraz Shaikh
- Brooke Army Medical Center, Fort Sam Houston, Texas; Walter Reed National Military Medical Center, Bethesda, Maryland; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Ping Li
- Brooke Army Medical Center, Fort Sam Houston, Texas; Walter Reed National Military Medical Center, Bethesda, Maryland; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Deepak Aggarwal
- Brooke Army Medical Center, Fort Sam Houston, Texas; Walter Reed National Military Medical Center, Bethesda, Maryland; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Landstuhl Regional Medical Center, Landstuhl, Germany
| | - M Leigh Carson
- Brooke Army Medical Center, Fort Sam Houston, Texas; Walter Reed National Military Medical Center, Bethesda, Maryland; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Landstuhl Regional Medical Center, Landstuhl, Germany
| | - Clinton K Murray
- Brooke Army Medical Center, Fort Sam Houston, Texas; Walter Reed National Military Medical Center, Bethesda, Maryland; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, Maryland; Landstuhl Regional Medical Center, Landstuhl, Germany
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Shaw AG, Vento TJ, Mende K, Kreft RE, Ehrlich GD, Wenke JC, Spirk T, Landrum ML, Zera W, Cheatle KA, Guymon C, Calvano TP, Rini EA, Tully CC, Beckius ML, Murray CK. Detection of methicillin-resistant and methicillin-susceptible Staphylococcus aureus colonization of healthy military personnel by traditional culture, PCR, and mass spectrometry. ACTA ACUST UNITED AC 2013; 45:752-9. [PMID: 23957540 DOI: 10.3109/00365548.2013.816439] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Methicillin-resistant (MRSA) and methicillin-susceptible (MSSA) Staphylococcus aureus colonization is associated with increased rates of infection. Rapid and reliable detection methods are needed to identify colonization of nares and extra-nare sites, particularly given recent reports of oropharynx-only colonization. Detection methods for MRSA/MSSA colonization include culture, PCR, and novel methods such as PCR/electrospray ionization time-of-flight mass spectrometry (ESI-TOF-MS). METHODS We evaluated 101 healthy military members for S. aureus colonization in the nares, oropharynx, axilla, and groin, using CHROMagar S. aureus medium and Xpert SA Nasal Complete PCR for MRSA/MSSA detection. The same subjects were screened in the nares, oropharynx, and groin using PCR/ESI-TOF-MS. RESULTS By culture, 3 subjects were MRSA-colonized (all oropharynx) and 34 subjects were MSSA-colonized (all 4 sites). PCR detected oropharyngeal MRSA in 2 subjects, which correlated with culture findings. By PCR, 47 subjects were MSSA-colonized (all 4 sites); however, 43 axillary samples were invalid, 39 of which were associated with deodorant/anti-perspirant use (93%, p < 0.01). By PCR/ESI-TOF-MS, 4 subjects were MRSA-colonized, 2 in the nares and 2 in the oropharynx; however, neither of these correlated with positive MRSA cultures. Twenty-eight subjects had MSSA by PCR/ESI-TOF-MS, and 41 were found to have possible MRSA (S. aureus with mecA and coagulase-negative Staphylococcus (CoNS)). CONCLUSION The overall 3% MRSA colonization rate is consistent with historical reports, but the oropharynx-only colonization supports more recent findings. In addition, the use of deodorant/anti-perspirant invalidated axillary PCR samples, limiting its utility. Defining MRSA positivity by PCR/ESI-TOF-MS is complicated by co-colonization of S. aureus with CoNS, which can also carry mecA.
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Affiliation(s)
- Ashley G Shaw
- From the 1 San Antonio Military Medical Center, Fort Sam Houston , Texas
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Vento TJ, Calvano TP, Cole DW, Mende K, Rini EA, Tully CC, Landrum ML, Zera W, Guymon CH, Yu X, Beckius ML, Cheatle KA, Murray CK. Staphylococcus aureus colonization of healthy military service members in the United States and Afghanistan. BMC Infect Dis 2013; 13:325. [PMID: 24060181 PMCID: PMC3716974 DOI: 10.1186/1471-2334-13-325] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 07/15/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Staphylococcus aureus [methicillin-resistant and methicillin-susceptible (MRSA/MSSA)] is a leading cause of infections in military personnel, but there are limited data regarding baseline colonization of individuals while deployed. We conducted a pilot study to screen non-deployed and deployed healthy military service members for MRSA/MSSA colonization at various anatomic sites and assessed isolates for molecular differences. METHODS Colonization point-prevalence of 101 military personnel in the US and 100 in Afghanistan was determined by swabbing 7 anatomic sites. US-based individuals had received no antibiotics within 30 days, and Afghanistan-deployed personnel were taking doxycycline for malaria prophylaxis. Isolates underwent identification and testing for antimicrobial resistance, virulence factors, and pulsed-field type (PFT). RESULTS 4 individuals in the US (4 isolates- 3 oropharynx, 1 perirectal) and 4 in Afghanistan (6 isolates- 2 oropharynx, 2 nare, 1 hand, 1 foot) were colonized with MRSA. Among US-based personnel, 3 had USA300 (1 PVL+) and 1 USA700. Among Afghanistan-based personnel, 1 had USA300 (PVL+), 1 USA800 and 2 USA1000. MSSA was present in 40 (71 isolates-25 oropharynx, 15 nare) of the US-based and 32 (65 isolates- 16 oropharynx, 24 nare) of the Afghanistan-based individuals. 56 (79%) US and 41(63%) Afghanistan-based individuals had MSSA isolates recovered from extra-nare sites. The most common MSSA PFTs were USA200 (9 isolates) in the US and USA800 (7 isolates) in Afghanistan. MRSA/MSSA isolates were susceptible to doxycycline in all but 3 personnel (1 US, 2 Afghanistan; all were MSSA isolates that carried tetM). CONCLUSION MRSA and MSSA colonization of military personnel was not associated with deployment status or doxycycline exposure. Higher S. aureus oropharynx colonization rates were observed and may warrant changes in decolonization practices.
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Affiliation(s)
- Todd J Vento
- Brooke Army Medical Center/San Antonio Military Medical Center, Fort Sam Houston, Fort Sam Houston, TX 78234, USA
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Vento TJ, Cole DW, Mende K, Calvano TP, Rini EA, Tully CC, Zera WC, Guymon CH, Yu X, Cheatle KA, Akers KS, Beckius ML, Landrum ML, Murray CK. Multidrug-resistant gram-negative bacteria colonization of healthy US military personnel in the US and Afghanistan. BMC Infect Dis 2013; 13:68. [PMID: 23384348 PMCID: PMC3610270 DOI: 10.1186/1471-2334-13-68] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Accepted: 01/29/2013] [Indexed: 11/10/2022] Open
Abstract
Background The US military has seen steady increases in multidrug-resistant (MDR) gram-negative bacteria (GNB) infections in casualties from Iraq and Afghanistan. This study evaluates the prevalence of MDR GNB colonization in US military personnel. Methods GNB colonization surveillance of healthy, asymptomatic military personnel (101 in the US and 100 in Afghanistan) was performed by swabbing 7 anatomical sites. US-based personnel had received no antibiotics within 30 days of specimen collection, and Afghanistan-based personnel were receiving doxycycline for malaria chemoprophylaxis at time of specimen collection. Isolates underwent genotypic and phenotypic characterization. Results The only colonizing MDR GNB recovered in both populations was Escherichia coli (p=0.01), which was seen in 2% of US-based personnel (all perirectal) and 11% of Afghanistan-based personnel (10 perirectal, 1 foot+groin). Individuals with higher off-base exposures in Afghanistan did not show a difference in overall GNB colonization or MDR E. coli colonization, compared with those with limited off-base exposures. Conclusion Healthy US- and Afghanistan-based military personnel have community onset-MDR E. coli colonization, with Afghanistan-based personnel showing a 5.5-fold higher prevalence. The association of doxycycline prophylaxis or other exposures with antimicrobial resistance and increased rates of MDR E. coli colonization needs further evaluation.
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Affiliation(s)
- Todd J Vento
- Brooke Army Medical Center/San Antonio Military Medical Center, Fort Sam Houston, TX, USA
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