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Injured Soldiers Bring Home Rare Infection
By K.L. CAPOZZA
http://www.sciencedaily.com/upi/index.php?feed=Science&article=UPI-1-20051007-21490300-bc-us-newinfections.xml

SAN FRANCISCO, Oct. 7 (UPI) -- A recent outbreak of Acinetobacter baumannii infections among patients at military medical facilities across the country is presenting a treatment challenge for clinicians, adding to the cost of medical care, and raising concerns that injured soldiers may be importing rare bugs from overseas into U.S. hospitals.

Since March 2003, more than 250 injured soldiers have been diagnosed with A. baumannii infection. All of them were wounded in combat in Iraq and Afghanistan, and treated at four military hospitals in the United States and abroad: Walter Reed Army Medical Center in Washington, D.C., Landstuhl Regional Medical Center in Landstuhl, Germany, the U.S. Naval Ship Comfort and a field hospital in Iraq.

"Essentially, it's being imported into our hospitals," said Dr. Paul Scott, chief of epidemiology and threat assessment at Walter Reed's research branch.

Researchers at both Walter Reed and the Centers for Disease Control and Prevention in Atlanta initially thought the infections were caused by soil contamination of combat wounds -- A. baumannii exists in the environment and was found to be prevalent among injured Vietnam War veterans.

Dr. Scott's study of 148 infected patients revealed that the cases are likely hospital-acquired and point to the need for improved institutional hygiene practices in military treatment facilities.

Scott presented his findings at the annual meeting of the Infectious Diseases Society of America.

The majority of military personnel tend be young and in relatively good health, which is why most of the patients infected by A. baumannii recovered after treatment, but researchers noted several non-military patients may have died as a result of complications from the infection, which they contracted in the military hospitals.

Dr. Stephen Wilson, a researcher at Indiana University School of Medicine, said the costs associated with this rare and difficult to treat infection are staggering.

In a study last year in the American Journal of Infection Control, he noted the average total hospital cost of burn patients who acquired A. baumannii was $98,575 higher than the cost for control patients who were not infected with the bacterium.

A. baumannii is a relatively common cause of health care-associated infections in Europe and Israel, but is rarely seen in U.S. hospitals. Because the organism has developed high resistance to antimicrobial treatments, it has become increasingly difficult to treat.

Physicians generally identify an appropriate treatment for each infection on an individual case basis because A. baumannii easily mutates to develop resistance to antibiotics. In the recent military outbreak, only two antibiotics, imipenem and amikacin, were effective against A. baumannii in more than 50 percent of the cases.

The outbreak drives home the lesson that, in a global economy, diseases have no borders. Moreover, the cost of infection control is pennies on the dollar compared with the cost of containing and treating rare disease outbreaks.

K.L. Capozza covers healthcare matters for UPI. E-mail: sciencemail@upi.com