title: Multi-drug resistant Acinetobacter infections in critically injured Canadian forces soldiers.
abstract: BACKGROUND
  Military members, injured in Afghanistan or Iraq, have returned home with multi-drug resistant Acinetobacter baumannii infections. The source of these infections is unknown.
  
  
  METHODS
  Retrospective study of all Canadian soldiers who were injured in Afghanistan and who required mechanical ventilation from January 1 2006 to September 1 2006. Patients who developed A. baumannii ventilator associated pneumonia (VAP) were identified. All A. baumannii isolates were retrieved for study patients and compared with A. baumannii isolates from environmental sources from the Kandahar military hospital using pulsed-field gel electrophoresis (PFGE).
  
  
  RESULTS
  During the study period, six Canadian Forces (CF) soldiers were injured in Afghanistan, required mechanical ventilation and were repatriated to Canadian hospitals. Four of these patients developed A. baumannii VAP. A. baumannii was also isolated from one environmental source in Kandahar - a ventilator air intake filter. Patient isolates were genetically indistinguishable from each other and from the isolates cultured from the ventilator filter. These isolates were resistant to numerous classes of antimicrobials including the carbapenems.
  
  
  CONCLUSIONS
  These results suggest that the source of A. baumannii infection for these four patients was an environmental source in the military field hospital in Kandahar. A causal linkage, however, was not established with the ventilator. This study suggests that infection control efforts and further research should be focused on the military field hospital environment to prevent further multi-drug resistant A. baumannii infections in injured soldiers.
authors: The Trauma Program, and Department of Surgery, Sunnybrook Health Sciences Centre, H186-2075 Bayview Avenue, Toronto, Canada, M4N 3M5. homer.tien@sunnybrook.ca
authors: Homer C
authors: HC
authors: Tien
authors: Anthony
authors: A
authors: Battad
authors: Elizabeth A
authors: EA
authors: Bryce
authors: Jeffrey
authors: J
authors: Fuller
authors: Michael
authors: M
authors: Mulvey
authors: Kathy
authors: K
authors: Bernard
authors: Ronald
authors: R
authors: Brisebois
authors: Jay J
authors: JJ
authors: Doucet
authors: Sandro B
authors: SB
authors: Rizoli
authors: Robert
authors: R
authors: Fowler
authors: Andrew
authors: A
authors: Simor
mesh_terms: D000151:Acinetobacter Infections / Q000453:epidemiology* / Q000382:microbiology; D040981:Acinetobacter baumannii / Q000145:classification* / Q000187:drug effects / Q000235:genetics; D000328:Adult; D000346:Afghanistan / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D015373:Bacterial Typing Techniques; D004269:DNA, Bacterial / Q000235:genetics; D024901:Drug Resistance, Multiple, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D006772:Hospitals, Military; D006801:Humans; D008851:Micropore Filters / Q000382:microbiology; D008889:Military Personnel; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000382:microbiology; D012189:Retrospective Studies; D012307:Risk Factors; D012122:Ventilators, Mechanical / Q000382:microbiology; D014947:Wounds and Injuries / Q000150:complications
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial
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