Authors: Murray, Clinton K.¹; Roop, Stuart A.²; Hospenthal, Duane R.¹; Dooley, David P.¹; Wenner, Kimberly³; Hammock, John³; Taufen, Neil³; Gourdine, Emmett³

Source: Military Medicine, Volume 171, Number 9, September 2006 , pp. 826-829(4)

Publisher: AMSUS - Association of Military Surgeons of the U.S.

Abstract:

Bacterial contamination of war wounds occurs either at the time of injury or during the course of therapy. Characterization of the bacteria recovered at the time of initial trauma could influence the selection of empiric antimicrobial agents used to prevent infection. In the spring of 2004, U.S. military casualties who presented to the 31st Combat Support Hospital in Baghdad, Iraq, with acute traumatic injuries resulting in open wounds underwent aerobic culture of their wounds to identify the bacteria colonizing the wounds. Forty-nine casualties with 61 separate wounds were evaluated. Wounds were located predominantly in the upper and lower extremities and were primarily from improvised explosive devices or mortars. Thirty wounds (49%) had bacteria recovered on culture, with 40 bacteria identified. Eighteen casualties (20 wounds) had undergone field medical therapy (irrigation and/or antimicrobial treatment); six of these had nine bacterial isolates on culture. Of the 41 wounds from 31 patients who had received no previous therapy, 24 grew 31 bacteria. Gram-positive bacteria (93%), mostly skin-commensal bacteria, were the predominant organisms identified. Only three Gram-negative bacteria were detected, none of which were characterized as broadly resistant to antimicrobial agents. The only resistant bacteria recovered were two isolates of methicillin-resistant Staphylococcus aureus (MRSA). Our assessment of war wound bacterioly soon after injury reveals a predominance of Gram-positive organisms of low virulence and pathogenicity. The presence of MRSA in wounds likely reflects the increasing incidence of community-acquired MRSA bacteria. These data suggest that the use of broad-spectrum antibiotics with efficacy against more resistant, Gram-negative bacteria, such as Pseudomonas aeruginosa and Acinetobacter spp., is unnecessary in early wound management.

Document Type: Research article

Affiliations: 1: Department of Medicine, Infectious Disease Service, Brooke Army Medical Center, Fort Sam Houston, TX 78234. 2: Department of Medicine, Pulmonary and Critical Care Service, William Beaumont Army Medical Center, Fort Bliss, TX 79920. 3: 31st Combat Support Hospital, Baghdad, Iraq.

Publication date: 2006-09-01

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• Military Medicine is the Association's official monthly journal. The objective of the Journal is to promote awareness of Federal medicine by providing a forum for responsible discussion of common ideas and problems relevant to Federal healthcare. Its mission is: To increase healthcare education by providing scientific and other information to its readers; to facilitate communication; and to offer a prestige publication for members' writings.
  
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• By this author: Murray, Clinton K. ;  Roop, Stuart A. ;  Hospenthal, Duane R. ;  Dooley, David P. ;  Wenner, Kimberly ;  Hammock, John ;  Taufen, Neil ;  Gourdine, Emmett

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