title: Impact of Operational Theater on Combat and Noncombat Trauma-Related Infections.
abstract: The Trauma Infectious Disease Outcomes Study began in June 2009 as combat operations were decreasing in Iraq and increasing in Afghanistan. Our analysis examines the rate of infections of wounded U.S. military personnel from operational theaters in Iraq and Afghanistan admitted to Landstuhl Regional Medical Center between June 2009 and December 2013 and transferred to a participating U.S. hospital. Infection risk factors were examined in a multivariate logistic regression analysis (expressed as odds ratios [OR]; 95% confidence intervals [CI]). The study population includes 524 wounded military personnel from Iraq and 4,766 from Afghanistan. The proportion of patients with at least one infection was 28% and 34% from the Iraq and Afghanistan theaters, respectively. The incidence density rate was 2.0 (per 100 person-days) for Iraq and 2.7 infections for Afghanistan. Independent risk factors included large-volume blood product transfusions (OR: 10.68; CI: 6.73-16.95), high Injury Severity Score (OR: 2.48; CI: 1.81-3.41), and improvised explosive device injury mechanism (OR: 1.84; CI: 1.35-2.49). Operational theater (OR: 1.32; CI: 0.87-1.99) was not a risk factor. The difference in infection rates between operational theaters is primarily a result of increased injury severity in Afghanistan from a higher proportion of blast-related trauma during the study period.
authors.affiliation: Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics 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: Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics 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, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889.
authors.forename: Tyler E
authors.initials: TE
authors.lastname: Warkentien
authors.affiliation: Infectious Disease Service, San Antonio Military Medical Center, 3551 Roger Brooke Drive No. 3600, Fort Sam Houston, San Antonio, TX 78234.
authors.forename: Bradley A
authors.initials: BA
authors.lastname: Lloyd
authors.affiliation: Infectious Disease, Landstuhl Regional Medical Center, CMR 402, Box 1559, APO AE 09180, Landstuhl, Germany.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Schnaubelt
authors.affiliation: The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., 6720A Rockledge Drive, Suite 100, Bethesda, MD 20817.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Ganesan
authors.affiliation: Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: William
authors.initials: W
authors.lastname: Bradley
authors.affiliation: Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: Deepak
authors.initials: D
authors.lastname: Aggarwal
authors.affiliation: Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: M Leigh
authors.initials: ML
authors.lastname: Carson
authors.affiliation: Infectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
authors.forename: Amy C
authors.initials: AC
authors.lastname: Weintrob
authors.affiliation: Infectious Disease Service, San Antonio Military Medical Center, 3551 Roger Brooke Drive No. 3600, Fort Sam Houston, San Antonio, TX 78234.
authors.forename: Clinton K
authors.initials: CK
authors.lastname: Murray
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D054542:Iraq War, 2003-2011; D008297:Male; D008889:Military Personnel / Q000706:statistics & numerical data*; D016017:Odds Ratio; D009873:Operating Rooms / Q000592:standards; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States; D017132:Workplace / Q000592:standards* / Q000706:statistics & numerical data; D014946:Wound Infection / Q000209:etiology*