SINT MAARTEN, NETHERLANDS ANTILLES Be on the lookout for Acinetobacter baumannii infections among wounded military personnel returning to the United States, an expert warned.
"This is a major problem with our soldiers returning from Iraq and Afghanistan," according to Dr. Theodore Rosen, adding that the pathogen causes soft tissue and skin infections, osteomyelitis, and if left untreated, fatal bacteremia.
It is also a concern for their family members. "You have to ask them if a family member was fighting over in the Middle East and injured," Dr. Rosen said. "You need to pay attention because this can save a life," he said at the Caribbean Dermatology Symposium.
Primary care physicians and dermatologists may be the first to see the cutaneous manifestations of A. baumannii infection. "We have people who are reservists, they come back, and they come in with a boil or cellulitis," Dr. Rosen said. "Culture them, consult ID fast, and get them in the hospitalthey need intravenous drugs we don't normally give."
Multidrug resistance and a delay of weeks or months before clinical symptoms appear are other causes for concern with this gram-negative pathogen. A. baumannii is 100% sensitive only to colistin, 80%-plus to imipenem, and 50% to amikacin, according to a 2004 report (MMWR 2004;53:10636).
In that report, the Centers for Disease Control and Prevention had noted an increasing number of A. baumannii bloodstream infections in patients at military medical facilities treating service members injured in the Iraq/Kuwait region during Operation Iraqi Freedom and in Afghanistan during Operation Enduring Freedom. Officials identified 102 patients at military hospitals who met CDC criteria for A. baumannii infection between January 2002 and August 2004.
A. baumannii is found in soil and water. Combat trauma is often the cause of initial infection, which was the case for a 55-year-old man injured by a grenade in Iraq. The explosion caused material to enter his anterior thigh and created a large posterolateral hip exit wound and an open left subtrochanteric femur fracture. He was successfully treated with debridement and antibiotic therapy, according to the case report (Emerg. Infec. Dis. 2008;14:5124).
Infection also can be nosocomial. A. baumannii was implicated in the deaths of five noncombat patients at Walter Reed Army Medical Center in Washington, all of whom were infected by returning soldiers (Clin. Infect. Dis. 2006;43:1045).
"Now it is [also] felt to be acquired in military medical facilities," said Dr. Rosen, professor of dermatology and chief, VA Dermatology Clinic, Baylor College of Medicine, Houston.
The gram-negative, nonmotile A. baumannii bacteria (magnified 27,600x) is 100% sensitive only to colistin, 80%-plus to imipenem, and 50% to amikacin. CDC/MATTHEW J. ARDUINO, DRPH/JANICE CARR/JANA SWENSON