title: The majority of US combat casualty soft-tissue wounds are not infected or colonized upon arrival or during treatment at a continental US military medical facility.
abstract: BACKGROUND
  The microbiology of war wounds has changed as medicine and warfare have evolved. This study was designed to determine the microbial flora and bacterial quantification of present-day war wounds in US troops from Iraq and Afghanistan upon arrival at the National Naval Medical Center (NNMC).
  
  
  METHODS
  Patients with extremity combat wounds treated with a vacuum-assisted wound closure device were enrolled in study. Wounds were biopsied every 48 to 72 hours with quantitative microbiology performed on all biopsies.
  
  
  RESULTS
  Two hundred forty-two wound biopsies from 34 patients; 167 (69%) showed no growth, and 75 (31%) showed positive growth. The incidence of any bacterial isolation from biopsies weekly from the time of injury was 28% (first), 31% (second), and 37% (≥third). Acinetobacter baumannii was the most prevalent isolate.
  
  
  CONCLUSIONS
  Most soft-tissue wounds from Iraq and Afghanistan do not have significant bacterial burden upon arrival to and during initial treatment at NNMC. Improved evaluation of combat wound microbiology at all levels of care is warranted to determine shifts in microbiology and to impact care practices.
authors.affiliation: Department of Surgery, National Naval Medical Center, Bethesda, MD, USA. Forest.Sheppard@med.navy.mil
authors.forename: Forest R
authors.initials: FR
authors.lastname: Sheppard
authors.forename: Paul
authors.initials: P
authors.lastname: Keiser
authors.forename: David W
authors.initials: DW
authors.lastname: Craft
authors.forename: Fred
authors.initials: F
authors.lastname: Gage
authors.forename: Martin
authors.initials: M
authors.lastname: Robson
authors.forename: Trevor S
authors.initials: TS
authors.lastname: Brown
authors.forename: Kyle
authors.initials: K
authors.lastname: Petersen
authors.forename: Stephanie
authors.initials: S
authors.lastname: Sincock
authors.forename: Matt
authors.initials: M
authors.lastname: Kasper
authors.forename: Jason
authors.initials: J
authors.lastname: Hawksworth
authors.forename: Doug
authors.initials: D
authors.lastname: Tadaki
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Davis
authors.forename: Alexander
authors.initials: A
authors.lastname: Stojadinovic
authors.forename: Eric
authors.initials: E
authors.lastname: Elster
mesh_terms: D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D001419:Bacteria / Q000302:isolation & purification; D001706:Biopsy; D006760:Hospitalization; D006772:Hospitals, Military; D006801:Humans; D015994:Incidence; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel; D054843:Negative-Pressure Wound Therapy / Q000379:methods*; D012189:Retrospective Studies; D017695:Soft Tissue Injuries / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D015599:Trauma Severity Indices; D014481:United States / Q000453:epidemiology; D014946:Wound Infection / Q000175:diagnosis*; D055815:Young Adult