Subject(s)
Babesia microti/isolation & purification , Babesiosis/diagnosis , Aged , Anemia/complications , Anti-Infective Agents/therapeutic use , Atovaquone/therapeutic use , Azithromycin/therapeutic use , Babesiosis/complications , Babesiosis/drug therapy , Canada , Humans , Male , Thrombocytopenia/complications , Treatment OutcomeABSTRACT
Military personnel returning from Afghanistan and entering Canadian hospitals may be infected with multidrug resistant Acinetobacter baumannii. The Public Health Agency of Canada, in conjunction with the Canadian Forces, have developed an alert to inform hospitals of the potential for importation of Acinetobacter baumannii, and the appropriate precautionary measures that should be taken to prevent secondary spread within hospitals.
Subject(s)
Acinetobacter Infections/drug therapy , Acinetobacter baumannii/pathogenicity , Cross Infection/prevention & control , Hospitals, Military , Military Personnel , Wounds and Injuries/microbiology , Acinetobacter Infections/diagnosis , Acinetobacter baumannii/drug effects , Afghanistan , Canada , Drug Resistance, Multiple, Bacterial , Humans , Infection Control/methods , WarfareABSTRACT
BACKGROUND: Military members, injured in Afghanistan or Iraq, have returned home with multi-drug resistant Acinetobacter baumannii infections. The source of these infections is unknown. METHODS: Retrospective study of all Canadian soldiers who were injured in Afghanistan and who required mechanical ventilation from January 1 2006 to September 1 2006. Patients who developed A. baumannii ventilator associated pneumonia (VAP) were identified. All A. baumannii isolates were retrieved for study patients and compared with A. baumannii isolates from environmental sources from the Kandahar military hospital using pulsed-field gel electrophoresis (PFGE). RESULTS: During the study period, six Canadian Forces (CF) soldiers were injured in Afghanistan, required mechanical ventilation and were repatriated to Canadian hospitals. Four of these patients developed A. baumannii VAP. A. baumannii was also isolated from one environmental source in Kandahar - a ventilator air intake filter. Patient isolates were genetically indistinguishable from each other and from the isolates cultured from the ventilator filter. These isolates were resistant to numerous classes of antimicrobials including the carbapenems. CONCLUSION: These results suggest that the source of A. baumannii infection for these four patients was an environmental source in the military field hospital in Kandahar. A causal linkage, however, was not established with the ventilator. This study suggests that infection control efforts and further research should be focused on the military field hospital environment to prevent further multi-drug resistant A. baumannii infections in injured soldiers.
