title: Epidemiology and antimicrobial susceptibilities of wound isolates of obligate anaerobes from combat casualties.
abstract: Data from recent conflicts related to war wounds and obligate anaerobes are limited. We define the epidemiology and antimicrobial susceptibility of obligate anaerobes from Iraq and Afghanistan casualties (6/2009-12/2013), as well as their association with clinical outcomes. Susceptibility against eleven antibiotics (7 classes) was tested. Overall, 59 patients had 119 obligate anaerobes identified (83 were first isolates). Obligate anaerobes were isolated 7-13 days post-injury, primarily from lower extremity wounds (43%), and were largely Bacteroides spp. (42%) and Clostridium spp. (19%). Patients with pelvic wounds were more likely to have Bacteroides spp. and concomitant resistant gram-negative aerobes. Seventy-three percent of isolates were resistant to ≥1 antimicrobials. Bacteroides spp. demonstrated the most resistance (16% of first isolates). Patients with resistant isolates had similar outcomes to those with susceptible strains. Serial recovery of isolates occurred in 15% of patients and was significantly associated with isolation of Bacteroides spp., along with resistant gram-negative aerobes.
authors.affiliation: San Antonio Military Medical Center, Joint Base San Antonio, Fort Sam Houston, TX, USA. Electronic address: Brian.K.White100.mil@mail.mil.
authors.forename: Brian K
authors.initials: BK
authors.lastname: White
authors.affiliation: San Antonio Military Medical Center, Joint Base San Antonio, Fort Sam Houston, TX, USA; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA.
authors.forename: Katrin
authors.initials: K
authors.lastname: Mende
authors.affiliation: Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA; Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Weintrob
authors.affiliation: San Antonio Military Medical Center, Joint Base San Antonio, Fort Sam Houston, TX, USA.
authors.forename: Miriam L
authors.initials: ML
authors.lastname: Beckius
authors.affiliation: San Antonio Military Medical Center, Joint Base San Antonio, Fort Sam Houston, TX, USA; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA.
authors.forename: Wendy C
authors.initials: WC
authors.lastname: Zera
authors.affiliation: Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Lu
authors.affiliation: San Antonio Military Medical Center, Joint Base San Antonio, Fort Sam Houston, TX, USA; Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA; The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD USA.
authors.forename: William
authors.initials: W
authors.lastname: Bradley
authors.affiliation: Infectious Disease Clinical Research Program, Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
authors.forename: David R
authors.initials: DR
authors.lastname: Tribble
authors.affiliation: Landstuhl Regional Medical Center, Germany.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Schnaubelt
authors.affiliation: San Antonio Military Medical Center, Joint Base San Antonio, Fort Sam Houston, TX, USA.
authors.forename: Clinton K
authors.initials: CK
authors.lastname: Murray
mesh_terms: D000328:Adult; D000346:Afghanistan; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001421:Bacteria, Anaerobic / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology*; D024881:Drug Resistance, Bacterial; D006801:Humans; D007493:Iraq; D008297:Male; D008826:Microbial Sensitivity Tests; D016896:Treatment Outcome; D014857:Warfare; D014946:Wound Infection / Q000453:epidemiology* / Q000382:microbiology*; D014947:Wounds and Injuries / Q000150:complications*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Anaerobes; Antimicrobial susceptibility; Trauma-related infections; War wounds