Showing papers by "Clinton K. Murray published in 2007"
TL;DR: The findings suggest that environmental contamination of field hospitals and infection transmission within health care facilities played a major role in this outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus complex infection among US service members injured in Iraq.
Abstract: Background. We investigated an outbreak of multidrug-resistant Acinetobacter baumannii-calcoaceticus complex infection among US service members injured in Iraq. Methods. The investigation was conducted in Iraq and Kuwait, in the 2 military hospitals where the majority of injured service members were initially treated. After initially characterizing the outbreak, we evaluated 3 potential sources of infection for the period March 2003 to December 2004. The evaluation included screening samples that were obtained from the skin of patients for the presence of colonization and assessing the soil and health care environments for the presence of A. baumanii-calcoaceticus complex organisms. Isolates obtained from samples from patients in US Military treatment facilities, as well as environmental isolates, were genotypically characterized and compared using pulsed-field gel electrophoresis. Results. A. baumanii-calcoaceticus complex organisms were present on the skin in only 1 (0.6%) of 160 patients who were screened and in 1 (2%) of 49 soil samples. A. baumanii-calcoaceticus complex isolates were recovered from treatment areas in 7 of the 7 field hospitals sampled. Using pulsed-field gel electrophoresis, we identified 5 cluster groups in which isolates from patients were related to environmental isolates. One cluster included hospitalized patients who had not been deployed to Iraq. Among the clinical isolates, only imipenem, polymyxin B, and colistin demonstrated reliable in vitro antimicrobial activity. Generally, the environmental isolates were more drug susceptible than were the clinical isolates. Conclusions. Our findings suggest that environmental contamination of field hospitals and infection transmission within health care facilities played a major role in this outbreak. On the basis of these findings, maintaining infection control throughout the military health care system is essential. Novel strategies may be required to prevent the transmission of pathogens in combat field hospitals. Acinetobacter baumannii-calcoaceticus complex (ABC)
369 citations
TL;DR: Combat-associated type III tibial fractures are predominantly associated with infections due to gram-negative organisms, and these infections are generally successfully treated.
Abstract: Background. Combat is associated with high-energy explosive injuries, often resulting in open tibial fractures complicated by nonunion and infection. We characterize the infections seen in conjunction with combat-associated type III tibial fractures. Methods. We performed a retrospective medical records review to identify US military service members wounded in Iraq or Afghanistan with open diaphyseal tibial fractures who were admitted to our facility (Brooke Army Medical Center, Fort Sam Houston, Texas) between March 2003 and September 2006. Results. Of the 62 patients with open tibial fractures who were identified in our initial search, 40 had fractures that met our inclusion criteria as type III diaphyseal tibial fractures. Three patients were excluded because their fractures were managed with early limb amputation, and 2 were excluded because of incomplete follow-up records. Twenty-seven of these 35 patients had at least 1 organism present in initial deep-wound cultures that were performed at admission to the hospital. The pathogens that were identified most frequently were Acinetobacter, Enterobacter species, and Pseudomonas aeruginosa. Thirteen of the 35 patients had union times of 19 months that appeared to be associated with infection. None of the gram-negative bacteria identified in the initial wound cultures were recovered again at the time of a second operation; however, all patients had at least 1 staphylococcal organism. One patient had an organism present during initial culture and in the nonunion wound; this organisim was a methicillin-resistant Staphylococcus aureus strain that was inadvertently not treated. Five of 35 patients ultimately required limb amputation, with infectious complications cited as the reason for amputation in 4 of these cases. Conclusions. Combat-associated type III tibial fractures are predominantly associated with infections due to gram-negative organisms, and these infections are generally successfully treated. Recurrent infections are predominantly due to staphylococci.
267 citations
TL;DR: The susceptibilities of 142 Acinetobacter baumannii-calcoaceticus complex isolates to 13 antimicrobial agents to colistin, polymyxin B, and minocycline were determined by broth microdilution.
Abstract: The susceptibilities of 142 Acinetobacter baumannii-calcoaceticus complex isolates (95 from wounded U.S. soldiers deployed overseas) to 13 antimicrobial agents were determined by broth microdilution. The most active antimicrobial agents (≥95% of isolates susceptible) were colistin, polymyxin B, and minocycline.
118 citations
TL;DR: The etiology of FWI was diverse; fungi with known resistance to each of the three major classes of antifungals were isolated, suggesting empirical use of one class may be inadequate to treat FWI.
81 citations
TL;DR: Unrecognized leptospirosis can be a significant cause of “dengue-like” febrile illness in children and an enhanced ability to discriminate between leptosphereirosis and dengue early in illness will help guide the appropriate use of healthcare resources in often resource-limited settings.
Abstract: Background: Leptospirosis is an emerging zoonosis that is often under-recognized in children and commonly confused with dengue in tropical settings. An enhanced ability to distinguish leptospirosis from dengue in children would guide clinicians and public health personnel in the appropriate use of limited healthcare resources. Methodology/Principal Findings: We conducted a prospective, hospital-based, study of children with acute febrile illnesses and dengue in Thailand. Among the children without dengue, we identified those with leptospirosis using anti-leptospira IgM and microscopic agglutination titers in paired acute and convalescent blood samples. We then performed a case-control comparison of symptoms, signs, and clinical laboratory values between children with leptospirosis and dengue. In a semi-rural region of Thailand, leptospirosis accounted for 19% of the non-dengue acute febrile illnesses among children presenting during the rainy season. None of the children with leptospirosis were correctly diagnosed at the time of hospital discharge, and one third (33%) were erroneously diagnosed as dengue or scrub typhus. A predictive model to distinguish pediatric leptospirosis from dengue was generated using three variables: the absolute neutrophil count, plasma albumin, and aspartate aminotransferase levels in the first 72 hours of illness. Conclusions/Significance: Unrecognized leptospirosis can be a significant cause of ‘‘dengue-like’’ febrile illness in children. Increased awareness of pediatric leptospirosis, and an enhanced ability to discriminate between leptospirosis and dengue early in illness, will help guide the appropriate use of healthcare resources in often resource-limited settings.
64 citations
TL;DR: The high coinfection rates suggest that defining the etiologies of AFI is imperative in guiding proper disease treatment, prevention, and control strategies in Egypt.
Abstract: We report the occurrence of concurrent infections with multiple acute febrile illness (AFI) pathogens during an ongoing prospective laboratory-based surveillance in four infectious disease hospitals in urban and rural areas of Egypt from June 2005 to August 2006. Patients were screened for Leptospira, Rickettsia typhi, Brucella, or Salmonella enterica serogroup Typhi by various methods including serology, culture, and PCR. One hundred eighty-seven of 1,510 patients (12.4%) evaluated had supporting evidence for the presence of coinfections; 20 (1%) of these patients had 2 or more pathogens based upon confirmatory 4-fold rise in antibody titer, culture, and/or PCR. Most coinfected patients lived or worked in rural agricultural areas. The high coinfection rates suggest that defining the etiologies of AFI is imperative in guiding proper disease treatment, prevention, and control strategies in Egypt.
59 citations
TL;DR: Skin carriage of Acinetobacter calcoaceticus-baumannii complex was not detected among a representative sample of 102 US Army soldiers stationed in Iraq, refuting the hypothesis that preinjury skin carriage serves as the reservoir for the AcinetOBacter infections seen in US military combat casualties.
Abstract: Skin carriage of Acinetobacter calcoaceticus-baumannii complex was not detected among a representative sample of 102 US Army soldiers stationed in Iraq. This observation refutes the hypothesis that preinjury skin carriage serves as the reservoir for the Acinetobacter infections seen in US military combat casualties.
51 citations
TL;DR: The US military uses a 6-component approach to deployment medicine, emphasizing preparation, education, personal protective measures, vaccines, chemoprophylaxis, and surveillance in an attempt to prevent infectious diseases.
Abstract: The US military conducts missions that range from major ground combat operations to disaster and humanitarian relief efforts. A primary goal of military medical professionals is disease prevention, which can be made more difficult in the context of short preparation times and prolonged deployment duration. The military uses a 6-component approach to deployment medicine, emphasizing preparation, education, personal protective measures, vaccines, chemoprophylaxis, and surveillance in an attempt to prevent infectious diseases. Many of the components of military deployment medicine are applicable to civilian disaster relief and humanitarian missions.
43 citations
TL;DR: Three agents were evaluated for their abilities to prevent mortality in hamsters infected with a lethal inoculum of Leptospira interrogans serovar Portlandvere and each produced a statistically significant survival advantage compared to no treatment.
Abstract: Ciprofloxacin, gatifloxacin, and levofloxacin were evaluated for their abilities to prevent mortality in hamsters infected with a lethal inoculum of Leptospira interrogans serovar Portlandvere. Each agent produced a statistically significant survival advantage compared to no treatment and demonstrated survival similar to that seen with doxycycline therapy.
28 citations
TL;DR: Leptospirosis was found to be a frequently confirmed cause of morbidity in Kamphaeng Phet Province in those suspected of having the illness and screened predominantly with Bratislava, Autumnalis, and Icterohaemorrhagiae serovars.
Abstract: Leptospirosis, which is caused by pathogenic spirochetes of the genus Leptospira, is a zoonotic disease of global importance and an emerging health problem. We studied patients suspected of having leptospirosis in Kamphaeng Phet Province, Thailand. Of 106 patients with suspected leptospirosis evaluated at the provincial hospital, 69 (65%) were confirmed positive (titer ≥ 1:800 or ≥ 4-fold increase in titer) by microscopic agglutination testing. Seventy-seven percent (53) of the cases occurred during the rainy season (June through November). Sera reacted predominantly with Bratislava, Autumnalis, and Icterohaemorrhagiae serovars. The screening Leptospira Dip-S-Ticks test had poor sensitivity (32%) but a specificity of 100% compared with a Leptospira IgM enzyme-linked immunosorbent assay. Leptospirosis was found to be a frequently confirmed cause of morbidity in Kamphaeng Phet Province in those suspected of having the illness.
26 citations
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TL;DR: Infections remain a leading cause of death in burn patients, and for patients with burn size greater than 40% TBSA, 75% of all deaths are due to infection.
Abstract: Infections remain a leading cause of death in burn patients. For patients with burn size greater than 40% TBSA, 75% of all deaths are due to infection. Traditionally, gram-positive bacteria infect wounds during the first 48 hours after burn, followed by gram-negative and yeast in the next 5 to 7 day
TL;DR: The phenomenon of antimicrobial agent dependence has been infrequently described, with vancomycin-dependent Enterococcus faecalis first reported in 1994 and then occasionally thereafter, and heteroresistance of the Acinetobacter baumannii-Acinetobacteria calcoaceticus is reported.
Abstract: The phenomenon of antimicrobial agent dependence has been infrequently described, with vancomycin-dependent Enterococcus faecalis first reported in 1994 ([3][1]) and then occasionally thereafter ([7][2], [9][3]). Although heteroresistance of the Acinetobacter baumannii-Acinetobacter calcoaceticus
TL;DR: Posaconazole and caspofungin appear to have potential for use in treatment of this rare infection and improved survival of immunocompromised mice in this otherwise fatal disseminated phaeohyphomycosis.
Abstract: Disseminated phaeohyphomycosis is an uncommon infection affecting immunocompetent and immunocompromised individuals in which response to older antifungal agents has been variable. We compared the e...
TL;DR: In this article, the authors performed a retrospective review of the burned patients electronic medical records database for all blood cultures drawn between January 1997 and September 2005, and assessed blood cultures for positivity, organisms identified, and growth in aerobic or anaerobic media.