title: Bacteriology of war wounds at the time of injury.
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.
authors.affiliation: Department of Medicine, Infectious Disease Service, Brooke Army Medical Center, Fort Sam Houston, TX 78234, USA.
authors.forename: Clinton K
authors.initials: CK
authors.lastname: Murray
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Roop
authors.forename: Duane R
authors.initials: DR
authors.lastname: Hospenthal
authors.forename: David P
authors.initials: DP
authors.lastname: Dooley
authors.forename: Kimberly
authors.initials: K
authors.lastname: Wenner
authors.forename: John
authors.initials: J
authors.lastname: Hammock
authors.forename: Neil
authors.initials: N
authors.lastname: Taufen
authors.forename: Emmett
authors.initials: E
authors.lastname: Gourdine
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001431:Bacteriological Techniques; D024881:Drug Resistance, Bacterial; D006090:Gram-Negative Bacteria / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology* / Q000473:pathology; D006094:Gram-Positive Bacteria / Q000187:drug effects / Q000302:isolation & purification / Q000472:pathogenicity; D016908:Gram-Positive Bacterial Infections / Q000382:microbiology* / Q000473:pathology; D006772:Hospitals, Military; D006801:Humans; D007493:Iraq; D008826:Microbial Sensitivity Tests; D008887:Military Medicine; D008889:Military Personnel; D013997:Time Factors; D014481:United States; D014857:Warfare; D014947:Wounds and Injuries / Q000382:microbiology* / Q000473:pathology
chemical_list: D000900:Anti-Bacterial Agents