Infection Control and Prevention After Dismounted Complex Blast Injury
During recent operations in Afghanistan, dismounted complex blast injuries (DCBI) have become increasingly common, and due to improvements in combat casualty care, these injuries are more survivable than they have been at any time in history. These patients are at high risk for infectious complications with infection rates as high as 50% in intensive care unit patients. The pathogens involved are often unique, including multidrug-resistant organisms and invasive fungi. This chapter summarizes the current literature on the epidemiology, microbiology, and outcomes of infectious complications in the predominantly DCBI combat casualty population and defines recommended measures for preventing these complications. These include wound management, use of antimicrobials, and both strategic and tactical infection prevention and control priorities. These recommendations are applicable throughout the continuum of casualty care with an emphasis on preventing infection beginning from the time of injury.
KeywordsCombat Military Trauma Infection Prevention Wound
Conflicts of Interest
The authors declare no conflicts of interest and no funding source used in the preparation of this manuscript.
The views expressed herein are those of the authors and do not reflect the official policy or position of Brooke Army Medical Center, the US Army Medical Department, the US Army Office of the Surgeon General, the Department of the Air Force, the Department of the Army, the Department of Defense, or the US Government.
- 1.Dismounted complex blast injury: report of the army dismounted complex blast injury task force. 2011.Google Scholar
- 2.Center AFHS. Deployment-related conditions of special surveillance interest. Med Surveill Mon Rep. 2012;19(4):25.Google Scholar
- 4.Reilly C. A chance in hell, part 3: blood and grit. The Virginian-Pilot, 2011, 2.Google Scholar
- 7.Centers for Disease C, Prevention. Acinetobacter Baumannii infections among patients at military medical facilities treating injured U.S. service members, 2002-2004. MMWR Morb Mortal Wkly Rep. 2004;53(45):1063–6.Google Scholar
- 19.Keen EF, Mende K, Yun HC, Aldous WK, Wallum TE, Guymon CH, et al. Evaluation of potential environmental contamination sources for the presence of multidrug-resistant bacteria linked to wound infections in combat casualties. Infect Control Hosp Epidemiol Off J Soc Hosp Epidemiol Am. 2012;33(9):905–11.CrossRefGoogle Scholar
- 22.Scott P, Deye G, Srinivasan A, Murray C, Moran K, Hulten E, et al. An outbreak of multidrug-resistant Acinetobacter Baumannii-Calcoaceticus Complex infection in the US military health care system associated with military operations in Iraq. Clin Infect Dis Off Publ Infect Dis Soc Am. 2007;44(12):1577–84.CrossRefGoogle Scholar
- 27.Janvier F, Delacour H, Tesse S, Larreche S, Sanmartin N, Ollat D, et al. Faecal carriage of extended-spectrum beta-lactamase-producing enterobacteria among soldiers at admission in a French military hospital after aeromedical evacuation from overseas. Eur J Clin Microbiol Infect Dis Off Publ Eur Soc Clin Microbiol. 2014;33:1719.CrossRefGoogle Scholar
- 33.Sutter DE, Bradshaw LU, Simkins LH, Summers AM, Atha M, Elwood RL, et al. High incidence of multidrug-resistant gram-negative bacteria recovered from Afghan patients at a deployed US military hospital. Infect Control Hosp Epidemiol Off J Soc Hosp Epidemiol Am. 2011;32(9):854–60.CrossRefGoogle Scholar
- 55.Giannou C, Baldan M, for the International Committee of the Red Cross. War surgery: working with limited resources in armed conflict and other situations of violence, vol. 1; 2010. p. Geneva–ICRC.Google Scholar
- 57.Hospenthal DR, Murray CK, Andersen RC, Bell RB, Calhoun JH, Cancio LC, et al. Guidelines for the prevention of infections associated with combat-related injuries: 2011 update: endorsed by the Infectious Diseases Society of America and the Surgical Infection Society. J Trauma. 2011;71(2 Suppl 2):S210–34.CrossRefGoogle Scholar
- 61.Lloyd B, Murray CK, Shaikh F, Schnaubelt E, Whitman T, Blyth DM, Carson L, Tribble DR. Addition of fluoroquinolones or aminoglycosides to post-trauma antibiotic prophylaxis does not decrease risk of early osteomyelitis. IDWeek; 28 October 2016; New Orleans, LA, 2016.Google Scholar
- 64.Joint Theater Trauma System Clinical Practice Guideline: Invasive Fungal Infection in War Wounds. 2016.Google Scholar
- 66.Yun HC, Murray CK. Infection prevention in the deployed environment. US Army Med Dep J. 2016;(2–16):114–8.Google Scholar
- 69.Joint Theater Trauma System Clinical Practice Guideline: Ventilator Associated Pneumonia 2012 [Available from: http://www.usaisr.amedd.army.mil/assets/cpgs/Ventilator_Associated_Pneumonia_17_Jul_12.pdf.