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Evaluation of Potential Environmental Contamination Sources for the Presence of Multidrug-Resistant Bacteria Linked to Wound Infections in Combat Casualties

  • Edward F. Keen (a1), Katrin Mende (a1) (a2), Heather C. Yun (a1) (a3), Wade K. Aldous (a4), Timothy E. Wallum (a5), Charles H. Guymon (a5), David W. Cole (a6), Helen K. Crouch (a1), Matthew E. Griffith (a1) (a3), Bernadette L. Thompson (a1), Joel T. Rose (a4) and Clinton K. Murray (a1) (a3)...

To determine whether multidrug-resistant (MDR) gram-negative organisms are present in Afghanistan or Iraq soil samples, contaminate standard deployed hospital or modular operating rooms (ORs), or aerosolize during surgical procedures.


Active surveillance.


US military hospitals in the United States, Afghanistan, and Iraq.


Soil samples were collected from sites throughout Afghanistan and Iraq and analyzed for presence of MDR bacteria. Environmental sampling of selected newly established modular and deployed OR high-touch surfaces and equipment was performed to determine the presence of bacterial contamination. Gram-negative bacteria aerosolization during OR surgical procedures was determined by microbiological analysis of settle plate growth.


Subsurface soil sample isolates recovered in Afghanistan and Iraq included various pansusceptible members of Enterobacteriaceae, Vibrio species, Pseudomonas species, Acinetobacter Iwojfii, and coagulase-negative Staphylococcus (CNS). OR contamination studies in Afghanistan revealed 1 surface with a Micrococcus luteus. Newly established US-based modular ORs and the colocated fixed-facility ORs revealed no gram-negative bacterial contamination prior to the opening of the modular OR and 5 weeks later. Bacterial aerosolization during surgery in a deployed fixed hospital revealed a mean gram-negative bacteria colony count of 12.8 colony-forming units (CFU)/dm2/h (standard deviation [SD], 17.0) during surgeries and 6.5 CFU/dm2/h (SD, 7.5; P = .14) when the OR was not in use.


This study demonstrates no significant gram-negative bacilli colonization of modular and fixed-facility ORs or dirt and no significant aerosolization of these bacilli during surgical procedures. These results lend additional support to the role of nosocomial transmission of MDR pathogens or the colonization of the patient themselves prior to injury.

Corresponding author
Infectious Disease Service, San Antonio Military Medical Center, Brooke Army Medical Center, 3551 Roger Brooke Drive, Fort Sam Houston, TX 78234 (
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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
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