title: Healthcare-associated pneumonia among U.S. combat casualties, 2009 to 2010.
abstract: Although there is literature evaluating infectious complications associated with combat-related injuries from Iraq and Afghanistan, none have evaluated pneumonia specifically. Therefore, we assessed a series of pneumonia cases among wounded military personnel admitted to Landstuhl Regional Medical Center, and then evacuated further to participating U.S. military hospitals. Of the 423 casualties evacuated to the United States, 36 developed pneumonia (8.5%) and 30 of these (83.3%) were ventilator-associated. Restricting to 162 subjects admitted to intensive care, 30 patients had pneumonia (18.5%). The median Injury Severity Score was higher among subjects with pneumonia (23.0 vs. 6.0; p < 0.01). There were 61 first-isolate respiratory specimens recovered from 31 pneumonia subjects, of which 56.1% were gram-negative, 18.2% were gram-positive, and 18.2% were fungal. Staphylococcus aureus and Pseudomonas aeruginosa were most commonly recovered (10.6%, and 9.1%, respectively). Thirteen bacterial isolates (26.5%) were multidrug-resistant. Outcome data were available for 32 patients, of which 26 resolved their infection without progression, 5 resolved after initial progression, and 1 died. Overall, combat-injured casualties suffer a relatively high rate of pneumonia, particularly those requiring mechanical ventilation. Although gram-negative pathogens were common, S. aureus was most frequently isolated. Continued focus on pneumonia prevention strategies is necessary for improving combat care.
authors.affiliation: San Antonio Military Medical Center, 3551 Roger Brooke Drive MCHE-MDI, JBSA Fort Sam Houston, TX 78234.
authors.forename: Heather C
authors.initials: HC
authors.lastname: Yun
authors.affiliation: Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20814.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Weintrob
authors.affiliation: Keesler Medical Center, 301 Fisher Street, Keesler Air Force Base, MS 39534.
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Conger
authors.affiliation: Infectious Disease Clinical Research Program, Preventive Medicine and Biometrics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: Ping
authors.initials: P
authors.lastname: Li
authors.affiliation: Infectious Disease Clinical Research Program, Preventive Medicine and Biometrics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: Dan
authors.initials: D
authors.lastname: Lu
authors.affiliation: Infectious Disease Clinical Research Program, Preventive Medicine and Biometrics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: David R
authors.initials: DR
authors.lastname: Tribble
authors.affiliation: San Antonio Military Medical Center, 3551 Roger Brooke Drive MCHE-MDI, JBSA Fort Sam Houston, TX 78234.
authors.forename: Clinton K
authors.initials: CK
authors.lastname: Murray
mesh_terms: D000328:Adult; D005260:Female; D006772:Hospitals, Military; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data*; D009181:Mycoses / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D018410:Pneumonia, Bacterial / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D053717:Pneumonia, Ventilator-Associated / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D016896:Treatment Outcome; D000067398:War-Related Injuries / Q000628:therapy*; D055815:Young Adult