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Gram-Negative Multidrug-Resistant Organism Colonization in a US Military Healthcare Facility in Iraq

Published online by Cambridge University Press:  02 January 2015

Julie Ake ,
Paul Scott ,
Glenn Wortmann ,
Xiao-Zhe Huang ,
Melissa Barber ,
Zhining Wang ,
Mikeljon Nikolich ,
David Van Echo ,
Amy Weintrob  and
Emil Lesho
Julie Ake*
Affiliation:
Infectious Diseases Service, Walter Reed Army Medical Center, Washington, DC US Military HIV Research Program-Division of Retrovirology, Walter Reed Army Institute of Research, Rockville, Maryland
Paul Scott
Affiliation:
US Military HIV Research Program-Division of Retrovirology, Walter Reed Army Institute of Research, Rockville, Maryland
Glenn Wortmann
Affiliation:
Infectious Diseases Service, Walter Reed Army Medical Center, Washington, DC
Xiao-Zhe Huang
Affiliation:
Division of Bacterial and Rickettsial Diseases, Walter Reed Army Institute of Research, Silver Spring, Maryland
Melissa Barber
Affiliation:
USU Infectious Disease Clinical Research Program, Bethesda, Maryland
Zhining Wang
Affiliation:
US Military HIV Research Program-Division of Retrovirology, Walter Reed Army Institute of Research, Rockville, Maryland
Mikeljon Nikolich
Affiliation:
Division of Bacterial and Rickettsial Diseases, Walter Reed Army Institute of Research, Silver Spring, Maryland
David Van Echo
Affiliation:
2nd Brigade Combat Team, 3rd Infantry Division, Iraq Hematology-Oncology Service, Walter Reed Army Medical Center, Washington, DC
Amy Weintrob
Affiliation:
USU Infectious Disease Clinical Research Program, Bethesda, Maryland
Emil Lesho
Affiliation:
Division of Bacterial and Rickettsial Diseases, Walter Reed Army Institute of Research, Silver Spring, Maryland 2nd Brigade Combat Team, 3rd Infantry Division, Iraq
*
US Military HIV Research Program-Division of Retrovirology, Walter Reed Army Institute of Research, 1600 East Gude Drive, Rockville, MD 20850 (jake@hivresearch.org)
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Abstract

Objective.

To investigate potential sources of gram-negative multidrug-resistant organisms (MDROs) in a deployed US military healthcare facility.

Design.

Active surveillance.

Methods.

Swab sampling of patients, hospital personnel, and environmental surfaces was performed before the opening of a new medical treatment facility in Iraq and then serially for the next 6 months. Multidrug resistant isolates were genotypically characterized using pulsed-field gel electrophoresis (PFGE). Univariate and multivariate analysis were performed to evaluate associations between patient characteristics and MDRO carriage.

Setting.

Deployed US military medical facility.

Results.

A total of 1,348 samples were obtained, yielding 654 isolates, 42 of which were MDROs. One hundred fifty-eight patients were sampled; swabs from 18 patients yielded 29 MDR isolates. Host nation patients comprised 89% of patients with MDROs and 37% of patients without MDROs (P < .001 ). Host nation patient status was also significantly associated with MDRO carriage in multivariate logistic regression analysis (adjusted odds ratio, 2.9; confidence interval, 1.3-6.3; P = .009). Bacteria with PFGE patterns matching those recovered from host nation patients were later isolated from environmental surfaces including recovery room patient monitors and the trauma bay floor.

Conclusions.

At this facility, MDRO isolation was predominantly obtained from newly admitted host nation patients,,which may reflect baseline colonization with MDROs in the community. Patient MDRO carriage was linked to subsequent environmental contamination. These findings support intensive infection control efforts in forward deployed facilities.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 32 , Issue 6 , June 2011 , pp. 545 - 552
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2011

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