Pathogens present in acute mangled extremities from Afghanistan and subsequent pathogen recovery.

Area of Science:

• Microbiology
• Trauma Surgery
• Infectious Diseases

Background:

• Changing epidemiology of pathogens in combat casualties necessitates updated understanding.
• Acute traumatic wounds in military personnel present unique challenges for infection control.

Purpose of the Study:

• To evaluate bacteria and fungi in acute traumatic wounds from combat casualties in Afghanistan.
• To characterize the microbial landscape of mangled lower extremity injuries.

Main Methods:

• Prospective study involving 10 explosive-device injured casualties with 14 mangled lower extremities.
• Wound cultures performed at Role 3 facilities from January 2013 to February 2014.
• Recording of pathogens during routine patient care and tracking across treatment facilities.

Main Results:

• Bacteria were recovered from all wounds at the time of injury.
• Low-virulence, environmental gram-negative bacteria were common colonizers.
• Multidrug-resistant bacteria were detected in three cultures at Role 5 facilities; molds were found at later treatment stages.

Conclusions:

• Mangled lower extremity combat injuries exhibit high contamination rates with environmental organisms.
• These contaminants are generally not associated with sustained infections during care.
• Early wound contamination is a significant factor in microbial findings.