Duane R. Hospenthal, MD, PhD, an infectious-disease physician at Brooke Army Medical Center in Texas.
Furthermore, despite the hype, he
said that essentially no military deaths can be directly attributed to Acinetobacter infection.
Hospenthal, who served as an infectious-disease consultant to the Army Surgeon General from 2005-2011, told U.S. Medicine that one contributor to the problem is the multitude of transmission opportunities created when wounded warriors are transferred thousands of miles from one treatment location to another.
"These folks are handed off by hundreds of people.
They may be transported 6,000 to 8,500 miles within days of being wounded," Hospenthal
"It's not like someone who is hit on the freeway and brought to the nearest trauma center and gets all of his
Acinetobacter baumannii, found in soil and water and even on the skin and in the guts of healthy people, can bespread by person-to-person contact or contact with contaminated surfaces, according to the CDC
Patients with compromised immune systems are most susceptible to infection.
Long flights, multiple airport landings and being moved from stretcher to ambulance to helicopter mean "lots of opportunity for cross-contamination," Hospenthal
The wounded servicemembers, who often suffer polytrauma, tend to see numerous physicians during the transport.
While the old trauma practice was to clean out a wound, debride it, pack it and not look at it for two or three days, physicians at far-flung locations may "want to see what is wrong" when the patient arrives, he
"There's not one guy seeing the patient every day for the last three days."
Another issue cited by Hospenthal
is the overuse of antibiotics, especially when resistant bacteria such as Acinetobacter were first identified in wounded troops.
Without adequate clinical-microbiology backup during the early years of Operation Iraqi Freedom, physicians had to use their best judgment on when and how to treat infections.
If they saw that more pressure was required to ventilate a patient or that the wound had a greenish ooze, they often would "broaden antimicrobial empiric coverage," he
The lack of conclusive information led to "overuse and indiscriminate use of broad-spectrum agents," which tends to increase pathogens' antibiotic resistance.
In addition, especially in Iraq, "We kept a lot of host nationals in hospitals way too long because we had no place to send them because of sectarian violence," Hospenthal