Antimicrobial Stewardship Challenges in the Deployed Setting.

Area of Science:

• Infectious Diseases
• Military Medicine
• Public Health

Background:

• Combat trauma frequently involves infections with multidrug-resistant organisms (MDROs).
• Overuse of antibiotics contributes to MDROs in combat casualties.
• Current antimicrobial stewardship in deployed settings is inconsistently reported.

Purpose of the Study:

• To comprehensively assess antimicrobial stewardship practices in U.S. Central Command operational theaters.
• To identify limitations in implementing national standards for antimicrobial stewardship.
• To evaluate antibiotic prophylaxis for combat-injured patients.

Main Methods:

• A modified survey tool assessed stewardship practices at medical facilities.
• On-site assessments and interviews were conducted by a multidisciplinary team.
• Thematic exploration of implementation barriers was performed.

Main Results:

• 67% of facilities had formal antimicrobial stewardship programs; 56% had assigned leaders.
• No military personnel received antimicrobial stewardship training; laboratory assets were limited.
• 89% had access to guidelines, but only 11% received adherence feedback.

Conclusions:

• Antimicrobial stewardship programs in theater are in early development.
• Key areas for improvement include expertise, high-impact efforts, lab support, and prescribing culture.
• Formalization, telehealth mentoring, and adherence feedback can mitigate risks.