A relatively benign bug becomes a highly lethal pathogen, known to U.S. soldiers as

Stay the Course
In the spring of 2004 the military and CDC sent a team of infectious disease specialists to Iraq to determine the source of the Acinetobacter
baumannii infections coming back with the wounded soldiers and civilians.   They found no Acinetobacter baumannii in the soil in Iraq.  It was
determined that one specific strain of Acinetobacter baumannii that was infecting most the soldiers matched a strain that originated in and
had been infecting hospitalized patients in Europe.  Despite this knowledge by their own discovery you will see repeated statements in
interviews and articles from the military that claim the Acinetobacter baumannii  originated in the soil in Iraq.

In November, Duane Hospenthal, an infectious-disease expert at Brooke Army Medical Center in Texas and a consultant to the Army Surgeon
General, said, "The question really has been: Is it coming from these old facilities we're using in Iraq? Is it coming from some of the Iraqi
patients we have? Is it normal flora for our deployed soldiers who have been there for a while? Or is it being blown into them from shrapnel,
dirt, and other materials by these explosive devices?"

Hospenthal added that he believes there is little cause for concern. "It's a low-grade, low-virulence pathogen that can be recovered from soil
and water. Without having it blasted into you or your being immunocompromised, it's not going to hurt you. We still see Acinetobacter, but
now that it's been recognized, people are less excited about it here.
It's hard for me to even understand if this is a big issue."

ut While Duane is rolling over for his bosses, Col. Bruno Petrucelli, the U.S. Army’s senior epidemiologist, says "the organism’s resistance
to most drugs as well as its high casualty rate makes it potentially very dangerous."

Now we have CNN rolling over for the Pentagon
May 9, 2007 Years after the military knew AB was not from the soil in Iraq
ROBERTS:  I'm just thinking about these stories out yesterday about these EFPs and other improvised-explosive devices, where insurgents
and terrorists and now coating them with animal excrement and other bits of awful to try to inflict, you know, greater casualties by, you know,
creating these wounds that just will not heal and become resistant to antibiotics.

CALDWELL: John, we continue to see them use any kind of tactic that can -- will, you know, inflict more casualties and cause more fear and
intimidation amongst the people and the security forces, just like they do with these chlorine tanks that they put on top of their bombs, so
they have a chlorine fume that is caused. I mean, it just shows you the type of nature the enemy we're fighting against over here and what
we're up -- having to deal with.

This interview shows the nature of the DoD/Pentagon and what we're up--having to deal with!
After months of refusing to discuss Acinetobacter publicly it appears the Pentagon has opened up with a misinformation campaign designed
to make it appear that this is a new mysterious problem that they are burdened with.  
The most obvious of these lies is that the bombs are spreading mysterious infections.  Biologics cannot withstand the intense heat produced
by bombs and IED's.
The disbursement method for biologics is more complicated
CNN Transcript May 8  The Situation Room    CNN Transcript May 9   American Morning
Illness in a Redeployed Soldier
Although malaria and leishmaniasis continue to be the
most common deployment-related illnesses,
brucellosis must also be considered in the differential
of any redeployed soldier with headache, fever, and
body aches

November 12, 2006
Dead men walking
At the NNMC in Bethesda, surgeons are pushing the
boundaries of surgery. The marines they are working on
have wounds from Iraq that have never been seen. The
injuries are infected and they are severe. The lessons
learnt are unique to this theatre and this war. They
cannot clean these wounds
Even the soil and water in Iraq carry a virulent strain of
bacteria. Acinetobacter is resistant to most common
antibiotics and, if left untreated, can lead to pneumonia,
fever and septicaemia. It has been identified in more
than 240 military personnel in the US since 2003, killing
five; and in British troops too
Genome of Meningitis Causing Bacteria
05/03/2007 - Yale University researchers have
sequenced the genome of a bacteria that can
cause various infections, including meningitis
and pneumonia.
Antibiotic resistance of Acinetobacter baumannii
isolates: data from Ibni Sina Hospital for the year 2002
Time for a little science perspective on the rare blood
infection experienced by U.S. Troops returning from the
Rare Blood Infection Surfaces in Injured U.S.
Although it was not known where the soldiers
contracted the infections, the Army said the
recent surge highlighted a need to improve
infection control in military hospitals.
Frightening Perspective
Flying ICU's save lives in Iraq

For example, doctors, nurses and medics in Iraq worry
far less about infection than they would at a hospital in
the U.S., although the staff works to keep everything as
clean as possible. The wounds themselves are often
the filthy aftermath of bomb explosions. In addition,
Iraq’s ever-present dust is always blowing,
sometimes even into the operating room. When
infections occur it is usually three or four days after an
injury. By that time, the patient is thousands of miles
IDSA: Wounded Soldiers Back From Iraq With
Multidrug-Resistant Acinetobacter
Several different military research groups have been
working on the problem from different angles, but all
seem to have come to the same conclusion: Infection
is occurring early in soldiers' post-injury medical care,
most likely while still in Iraq.
Superbug brought back by Iraq War Casualties
Experts in microbiology who were studying the links
between the infection and those wounded in Iraq,
said an injured soldier thought to have caught the
infection in Iraq may have caused a large outbreak
of the superbug in an intensive care unit in an NHS
hospital in south-east England.
Prospective study of risk factors for
ventilator-associated pneumonia caused by
Acinetobacter species
Previous use of ceftriaxone and ciprofloxacin are
independent risk factors for the development of
Multidrug-Resistant Acinetobacter Extremity
Infections in Soldiers
As previously noted, we initially suspected that
colonized soldiers themselves were the reservoir for
MDR Acinetobacter, and that this colonization was
obtained from the environment. This hypothesis was
based on 2 facts. First, these organisms are
ubiquitous in the environment (4,25), and inoculation
of these organisms into war wounds during
traumatic blast, shrapnel, or projectile injuries
seemed to be plausible. Second, Acinetobacter spp.
had previously been described as common
pathogens in war wounds (3), supporting the initial
hypothesis. However, these infections are
apparently similar to recently reported nosocomial
MDR Acinetobacter infections. Investigation into the
cause of these infections is ongoing, but the source
is unlikely to be environmental. Multiple follow-up
soil samples have not yielded Acinetobacter, yet it
has been recovered from environmental cultures
within field medical facilities. The final outcome of
this investigation is pending further analysis.
Prof's Study Deadly Germ Found in Iraq
A. baumannii, thought to reside in soil and water, can, if
left untreated, cause pneumonia, meningitis, respiratory
infections, sepsis and urinary tract infections. Upon
infection, the organism has a casualty rate of 75 percent.
Multidrug-Resistant Acinetobacter Hitchhiking to US
Military Hospitals With Wounded Soldiers
The infections do have a clinical impact on patients,
according to Dr. Scott's data, with infected patients
requiring significantly longer hospital stays, more
days in the intensive care, more days of antibiotic
therapy, and more surgeries, compared with
comparably wounded soldiers who are colonized with
the bacteria but not carrying active infections.
Healing, With New Limbs and Fragile Dreams
February 12, 2006

Most of the amputees returning from combat zones
have an infection, because a bomb blast can embed
bacteria, dirt or pieces of clothing deep into the wound,
Colonel Pasquina said. A severe infection could
require further amputation or possibly be fatal.
What Makes Acinetobacter So Scary?
by Mike the Mad Biologist

Acinetobacter, We're All Going to Die

Well, actually only about 30,000 per year, if we can
extrapolate from the Israeli experience. One of the things  
that makes Acinetobacter so dangerous is that it is multi-
drug resistant. Today, the Washington Post  summarizes
some Acinetobacter genomics work:  Acinetobacter
baumannii is a bacterium that lives in soil and water. Thirty
years ago, it rarely caused illness.  When it did, antibiotics
killed it.  Today A. baumannii is a huge problem.  It is
responsible for a prolonged outbreak of hospital-acquired
infections in Europe. In some places,  mortality is as high
as 25 percent, generally involving critically ill patients.
Recently, the microbe was  implicated in a spate of wound
infections in combat casualties in Iraq and Afghanistan.  
Last week, French researchers shed light on what has
made it such a microbial monster. Pierre-Edouard  Fournier
of the Institute for Structural Biology and Microbiology in
Marseille sequenced the genome of a  multidrug-resistant
strain and compared it with an ordinary one. He and
colleagues found an "island" of 45  antibiotic-resistance
genes, the biggest collection ever found in a bacterium.  ....
they deduced that 44 percent of the genes had been
imported from Pseudomonas..., 34 percent from  
Salmonella , 17 percent from Escherichia and 4 percent
from other species. The "island" apparently formed  
because a cluster of "mobile genetic elements" -- which
allow genes to move among bacteria -- permitted  one
strain to collect and warehouse the resistance genes of its
neighbors. Having just finished reading the PLoS Genetics
article, this island is screwy. An "island" refers to a large  
chunk of DNA (typically anywhere from ~0.2% – 5% of the
entire genome) that appears to have entered the  host
genome via horizontal transfer (note: these islands often
don't enter in one whole piece, but instead, in  smaller
piece. Analysis of a pathogenicity island in E. coli suggests
that there are multiple steps). Here's  some of the screwball
things:  The multidrug resistant Acinetobacter has 52
resistance genes. Yes, 52. 45 of those 52 genes are found
in this island. A very rough estimate (very rough) is that
about 50% of the  DNA in the island encodes for a
resistance genes, whereas in the rest of the genome, the
figure is about  0.05%. A lot of these genes seem to do the
same thing: for example, there are six sulfonamide
resistance genes. I  don't know if all of them are expressed,
or if having multiple copies is a way to increase resistance
(six  copies potentially means six times as much gene
product; this isn't far-fetched–'duplication as regulation'  
actually happens quite often in the lab). It has both mercury
and arsenic resistance operons, as well as genes for
resistance to lead, cobalt, zinc,  and cadmium. Cadmium? I
always thought cadmium killed just about everything. That's
just a taste. Leaving aside the public health implications,
this is an amazing bug. Several questions  come to mind:  
Do the other multidrug resistant Acinetobacter have the
same island? If they lack this particular island, has a
different island inserted in the same place in the genome?
Can we find variability within similar islands such that we
could reconstruct the evolution and spread of this  island?
Are those multiple gene copies functional? Did they arise
via duplication or independent transfer events?  We
definitely need to know more about this organism.  Update:
One reason this island is so scary is that all of these
resistance genes are physically linked (or  integrated). What
this means is that selection for resistance to any single
antibiotic (i.e., exposure to one  antibiotic) could maintain all
of the other genes. I really think we can not get a handle on
reversing the  problem of antibiotic resistance until we deal
with the linkage issue.     

Sunday, August 28, 2005
Acinetobacter baumannii: There's a New Bug
in Town
Influenza's bad enough, but now there's a bacterium to
worry about: Acinetobacter baumannii. A. baumannii is a
common bacterium that lives on and around humans and
typically doesn't cause disease; it's also common in soil. It's
a very hardy bug too: resistant to dessication, metabolically
versatile, and such. When the opportunity presents itself (e.
g., an open wound, an IV line, or catheter tube), it can cause
an infection, particularly in immunocompromised patients.

In the past, there have been several antibiotics that were
effective against A. baumannii, but now, we're finding
strains of A. baumannii that are resistant to all the standard
antibiotics. In fact, the only antibiotic that works against
these multi-drug resistant strains is colistin, which has
serious side effects (although it is preferable to, um, death).
In rare cases, even colistin doesn't work, meaning we have
nothing left in the chamber (although I don't know if
tigecycline works).

Drug resistant A. baumannii first made the news when it
started showing up in U.S. military hospitals. Currently, it's
thought that many of these cases are due to contamination
within the hospital or patient-to-patient spread, and not from
primary infections that the soldiers enter into the hospital
with. The CDC recommendations for treatment are:

Identification of colonized and infected patients, combined
with implementation of infection-control measures such as
hand-hygiene and contact-isolation precautions, might help
prevent transmission of this organism within medical
facilities... Interventions recommended by military medical
officials have included 1) institution of active surveillance of
groin, axillary, and/or wound cultures for A. baumannii for all
patients; 2) use of contact precautions for colonized or
infected patients; and 3) increased availability and use of
alcohol-based hand rubs.
Translated into English, essentially, we've almost returned
to the pre-antibiotic age: we can't treat it very effectively, so
we try to limit its spread. This is easier said than done.
According to a story in Nature Medicine (Aug. 11, 2005;
italics mine):

Drug-resistant A. baumannii has infected at least 240 US
soldiers since 2003, and five seriously ill patients who
shared wards with them became infected and died...Most
worrying is the bacterium’s ability to evolve resistance to a
broad range of antibiotics unusually quickly, leaving few
treatments for those who succumb. Scientists do not
understand how this happens, but they know that the
microbe has many ways to acquire resistance genes. And
some strains naturally contain enzymes that break down
some antibiotics. Researchers are also studying how the
bacterium can survive on dry surfaces, particularly plastics,
for many weeks. This enables bacteria to hang around on
wards even when strict hygiene is maintained.
Another disconcerting thing to note is that the bacterium
killed patients who didn't have the infection initially–the
bacterium spread from patient to patient in the hospital. And
this isn't just a problem in U.S. military hospitals. 24
hospitals in the UK have shut down wards because of A.
baumannii. Latin America has also experienced serious
trouble with it (and my next post on this subject will discuss
Latin America further). Israel has had problems too (italics

Yehuda Carmeli, an infectious-disease physician at the Tel
Aviv Sourasky Medical Center in Israel, describes the
situation as “a real danger”. The bacterium is endemic in
many wards in his hospital, surviving hygiene measures
that have seen off MRSA [multidrug resistant
Staphylococcus aureus]. Carmeli also speculates that the
bacterium has become more virulent as it has acquired
antibiotic resistance.
“We have calculated that 40% of our
patients who become infected with A. baumannii die
because of it,” he says.
Not four percent. Forty. This is an incredibly lethal rate of
infection. Before panic sets in, remember that these are
opportunistic pathogens: they need to get past your natural
defenses (i.e., skin, other barriers, and the immune
system). Unfortunately, we have an increasingly at-risk
immunocompromised population. An increasingly elderly
population that requires the occasional hospital stay and
frequent skin breaches (IV, dialysis, catheters) is at risk
(keep in mind that the soldiers in the U.S. hospitals weren't
immunocompromised, although they had suffered severe
trauma). Other at-risk groups include HIV patients and
those using immunosuppresants (e.g., transplants, cancer

From what little I've heard (and I'll be at a conference in late
September where hopefully I'll have more information),
there isn't one 'über-strain' of multi-drug resistant A.
The good news is that there isn't a virulent
form which is spreading because it's good at causing
disease. The bad news is that these multi-resistant
strains appear wherever broad-spectrum antibiotics are

Petrucelli says that military field hospitals are particularly
guilty of overusing antibiotics. Sterility is difficult to maintain,
so doctors tend to throw broad-spectrum antibiotics at the
wounded. “But this removes options later on,” he warns.

This is natural selection in action, pure and simple. Maybe
if we pretend evolution doesn't happen, the problem will
go away...
Outbreak of Acinetobacter linked to wound
care equipment
21 December – EurekAlert reported that
infection control experts at The Johns Hopkins
Hospital say tighter rules governing use of a
hand-held, high-pressure, water-pumping tool
to wash and clean wounds should be adopted
to improve the safety of wound care.
Correspondence Corner:
Steve Silberman
Hometown: San Francisco

Thank you for citing my Wired article on antibiotic-resistant
infections in US military hospitals, "The Invisible Enemy."
While the Lt. Col. seemed to enjoy the story, he's painting
with a pretty broad brush when he says that my story is "not
news." For years, Defense Department spokesmen have
been telling the press that the source of the bacteria in
question, which has infected or colonized over 700 wounded
US soldiers and killed at least five civilians in military
hospitals, was the Iraqi soil. The Lt. Col. perpetuates this
myth by referring to the bacteria as a "foreign bug,"
ostensibly from Iraq. In fact, as I point out in the article, the
primary source of the infections was the US combat-support
hospitals themselves.

The proliferation of the mistaken notion that the source of the
bacteria was Iraqi dirt leads not only to misconceptions
about how drug-resistant organisms are created (and can
be controlled), but to bad medical practice on the front lines,
which creates more death and disease. In a recent article in
the Canadian Medical Association Journal, a trauma
surgeon in Afghanistan was quoted as saying his team was
planning on building double doors in their field hospital to
keep out desert sand contaminated with this organism --
though it does not live in the sand, as the DoD has known
for at least a year and a half, while saying otherwise publicly.

The fact that the same strains of acinetobacter causing the
US military infections have now spread into civilian hospitals
in Europe where wounded troops receive care -- resulting in
the deaths of dozens of civilians in London -- is worth noting.
I interviewed several parents of wounded US soldiers who
were never told that their children were infected with a
potentially dangerous organism, and thus did not protect
themselves from carrying it out of the hospital into other
institutions. In one case cited in my story, the mother of a
Marine was not even told that her son had died of a bacterial
infection, but that he had expired as a result of his war
wounds. It took a VA investigation to uncover the truth.

So while the association of war and disease is as old as
war itself, and the evolution of drug-resistant organisms is a
problem worldwide, I'm confident that my story of this
particular pathogen, where it really came from, how it
spread, and how this epidemic has been covered up by the
DoD, was worthy of bringing to national attention.

Stephen L. Silberman - May 16, 2007
The primary source of these infections was not "mysterious"
to the investigators who conducted the Army's own
investigation this outbreak in 2004-2005, led by Col. Bruno
Petrucelli, the director of infection control at Walter Reed
Army Medical Center. What is indeed mysterious is why that
report (Epidemiological Consultation 12-HA-01JK-04) has
never been made public. In fact, the Defense Department
has known that these infections are nosocomially acquired
for quite some time, despite many public statements to the
contrary. In last August's issue of the Clinical Infectious
Diseases journal, doctors at Brooke Army Medical Center
said that ongoing investigations "tend to support
nosocomial transmission" -- and yet, here we are, nearly a
year later, back at the "mystery" stage.
I am a senior writer for Wired magazine, and I published an
in-depth feature story on these infections in our February
issue. I invite MedPage readers to read it. There is a lot of
new information in it that helps solve the alleged puzzle of
where these infections are coming from -- and what the
Defense Department has already done to reduce rates of

The Invisible Enemy
US Soldiers Bring Bug from Iraq

“It’s the cause of recent hospital-based outbreaks and
it’s very hard to eradicate.” said Paul Scott, MD, chief of
epidemiology and threat assessment, Division of
Retrovirology, Walter Reed Army Institution of
Research, Washington, D.C. “Essentially, it’s being
imported into our hospitals.”
Cause of drug-resistant wound
infections among soldiers in Iraq
down to hospitals not battlefield
Wednesday May 23, 2007
An outbreak of drug-resistant wound infections
among soldiers in Iraq likely came from the
hospitals where they were treated, not the
battlefield, according to a new study in the June
15 issue of Clinical Infectious Diseases,
currently available online.
US Soldiers in Iraq fighting drug-resistant bacteria
after injuries

May 2007
Note:  This is two years after the military already
confirmed that there was no AB in the soil in the Iraq
and that the bacteria was coming from the field

"If skin carriage is not the source of A.
calcoaceticus-baumannii complex infection, then the
other possibility is that the bacteria contaminates the
wounds after injury," explains Dr. Griffith. "This could
happen while an injured soldier is awaiting treatment or
in the hospital during or after receiving medical care."   
"This observation refutes the concept that the bacterium
is acquired prior to injury among soldiers deployed to
Iraq," Dr. Griffith says. "In addition, this observation
adds to the ever growing body of evidence implicating
nosocomial transmission as the cause of the ongoing
military outbreak."
Senator Craig Thomas a Victim of the
Iraq War?
He is suffering from infection

Medical Waste at Ibn Sina
Poor people searching for stuff in rubbish that can be
recycled or sold do not know what they can contract in
dumps. Bacterial or viral infections can be easily
contracted from the waste disposed by hospitals and
clinics," Kamel said, adding that medical waste
disposal had become a problem throughout the country.

Officials at the Ibn Sina Hospital in the northern city of
Mosul, 390km north of Baghdad, said there had rubbish
had not been collected for more than a week and that
poor people had been going through plastic bags of
medical waste.
Comparison of Acinetobacter Baumannii
isolates from the United Kingdom and the
United States that were associated with
Repatriated Casualties of the Iraq Conflict  
July 2006

In conclusion, at least one outbreak strain of
A. baumannii, responsible for further
infections in the hospitals concerned, is
associated with soldiers returning to the
United States or United Kingdom from Iraq
Wound care equipment linked to
Acinetobacter outbreak
February 2005
Subsequent culture testing of the open-space
treatment room for performing the procedure
showed widespread presence of A. baumannii
on the disposable parts of the pulsatile lavage
gun, including disposable tubing and suction
canister, as well as on cleaned stretchers, the
sink and nearby supply shelves.
U.S. soldiers returning with resistant Acinetobacter
baumannii infections
November 2005
Walter Reed officials have instituted isolation policies
and universal precautions, such as wearing gowns,
gloves and masks around positive patients.
“All of these patients in the initial outbreak were
severely wounded combat casualties who had either
limb or life-saving surgery at field hospitals in Iraq
before their evacuation
Antibiotic resistance of Acinetobacter
baumannii isolates: data from Ibni Sina
Hospital for the year 2002
Time for a little science perspective on the rare
blood infection experienced by U.S. Troops
returning from the battlefront.
Casualties of War: MSF Surgeons Treat Wounded
Drug-Resistant Infections

Nearly half of the patients needing orthopedic
procedures arrive in Amman with severe bone and
wound infections, which are often resistant to multiple
antibiotics. Unhygienic conditions in Iraqi hospitals and
significant delays in receiving treatment make patients
susceptible to infection.

"We are receiving patients with very difficult infections
from Iraq," says Dr. R. "In Iraq, the mismanagement and
misuse of antibiotics all lead to the appearance of
resistant bacteria. These bacteria are resistant to almost
all antibiotics except one or two. And these are the new
generation of antibiotics that are very expensive."
Dec 9, 2004
Injured soldiers from Iraq have also brought an
epidemic of multidrug-resistant Acinetobacter
baumanii infection to military hospitals.

It is not known how this has occurred. No such
epidemic appeared among soldiers from Afghanistan,
and whether the drug resistance is being produced by
antibiotic use or is already carried by the strains
colonizing troops is still being debated. Regardless,
data from 442 medical evacuees seen at Walter Reed
showed that 37 (8.4 percent) were culture-positive for
acinetobacter — a rate far higher than any previously
experienced. The organism has infected wounds and
prostheses and caused catheter-related sepsis in
soldiers and, through nosocomial spread, in at least
three other hospital patients. Medical evacuees from
Iraq are now routinely isolated on arrival and
Funding Request from
Tom Daschle
Dec 10, 2003
Our soldiers in Iraq have
been at risk of contracting
wound infections from
multi drug resistant
organisms such as
Acinetobacter.  Wound
infections are not only life
threatening they raise the
probability that patients
will require limb
Move over MRSA

New Test for
Acinetobacter baumanni
This organism has received recent press
attention because personnel wounded by IEDs
or combat in the Middle East show an
extraordinarily high incidence of MDR
Acinetobacter infections. In addition, MDR
Acinetobacter causes periodic outbreaks in
hospitals and is much more difficult to treat or
eradicate than MRSA. Some medical experts
believe that Acinetobacter and similar organisms
present a greater and more imminent threat
than MRSA. Strains that remain susceptible to
only one or two antibiotics are increasingly

Acinetobacter baumaniii
from Housefly's

A new study funded by Orkin Pest Control, Atlanta,
GA, [has shown] that
common house flies carry bacteria that has been linked
to meningitis. This
is the first time the bacterium _Acinetobacter
baumannii_ has been detected
from flies. For pest professionals who perform fly
control services, this
study has significant public health ramifications.

Health Officials warn hospitals of
Afghan Bug
Threat posed by highly resistant bacteria
underlines lack of preparedness
Federal authorities are warning hospitals across the
country to beware of a highly drug resistant bacteria
that wounded troops are bringing back from
Afghanistan -- and that could inadvertently be spread
to civilian patients.
Antibiograms of Multidrug-Resistant
Clinical Acinetobacter baumannii:
Promising Therapeutic Options for
Treatment of Infection with
Colistin-Resistant Strains

Whole Article

Multidrug-resistant Acinetobacter baumannii
infection has presented a global medical
challenge. The antibiograms of paired
colistin-susceptible and -resistant strains
revealed increased susceptibility of
colistin-resistant strains to most tested
antibiotics, including those that are active
against only gram-positive bacteria. Synergy
between colistin and rifampicin was
observed in the colistin-susceptible strains.
The ability to form biofilm in the
colistin-resistant strains was significantly
lower (P < .001) than in the parent strains.
Our study provides valuable information for
potential expansion of our current therapeutic
options against colistin-resistant A.
baumannii infection.
Survival of Acinetobacter baumannii on Dry Surfaces:
Comparison of Outbreak and Sporadic Isolates

Acinetobacter spp. are important nosocomial
pathogens reported with increasing frequency in
outbreaks of cross-infection during the past 2 decades.
The majority of such outbreaks are caused by
Acinetobacter baumannii.
Canadian Soldiers get Acinetobacter
baumannii from field hospitals in
Kandahar Afghanistan?

Published August 14, 2007

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

Superbug hits Canadian Soldiers injured in
Suicide Bombing

Last Updated Feb 23, 2006

The recovery of three Canadians wounded last
month in Afghanistan has been slowed by
battlefield bacteria infecting American troops in
Iraq, CBC News has learned.
Rapid Development of Acinetobacter baumannii
Resistance to Tigecycline
A 53-year-old woman experienced a multidrug-
resistant (MDR) Acinetobacter baumannii urinary
tract infection 5 months after undergoing kidney
and liver transplantation. The tigecycline
minimum inhibitory concentration (MIC) for her A.
baumannii isolate was 1.5 μg/ml; the patient
received 2 weeks of therapy with intravenous
tigecycline as a 100-mg loading dose followed by
50 mg every 12 hours, with no lapses in
treatment and with resolution of the infection.
Three weeks later, MDR A. baumannii was
isolated from her sputum in the setting of clinical
evidence of pneumonia, and tigecycline was
restarted; the tigecycline MIC for the A. baumannii
isolate was 2 μg/ml. At approximately the same
time, the patient was found to have a paraspinal
abscess and spinal osteomyelitis. Cultures of
the abscess fluid grew A. baumannii with a
tigecycline MIC of 24 μg/ml. A follow-up sputum
culture again yielded A. baumannii, but with a
tigecycline MIC of 24 μg/ml. Urine culture at that
time also grew A. baumannii with a tigecycline
MIC of 24 μg/ml. Clinicians should be aware that
tigecycline MICs for A. baumannii isolates may
increase during therapy with tigecycline after only
brief exposure to the drug. Patients receiving
tigecycline for Acinetobacter should be monitored
for the development of clinical resistance, and
isolates should be monitored for evidence of
microbiologic resistance.
Iraqi Civiilans being treated in US Medical facilities
are being infected with Acinetobacter baumanni
then cut loose to civiian medical facilities that do
not have the means to treat it.

Iraqi Health System rife with problems
By Kelly Kennedy

ASAD, Iraq — At the 399th Combat Support Hospital in mid-
July, a soldier carried an impossibly tiny, malnourished 5-
year-old boy into the emergency room with a gunshot
wound to the stomach.

Every doctor and nurse’s face registered a flash of sorrow,
but they immediately converged to treat him. After the child
had gone through surgery, the sorrow returned as doctors
talked about the next stage of treatment: the Iraqi health
care system.

“The Iraqi medical system was one of the best in the
Middle East prior to the Persian Gulf War,” said Col. Paul
Astphan, acting commander of the unit. “Now they look
upon their care as God’s will. If someone lives, great. If not,
it’s God’s will. That’s the Iraqi health care system.”

Statistics show 96 percent of Americans who make it to
military hospitals in Iraq survive. But though the Iraqi
soldiers, police officers and civilians who come into
American hospitals with the same life-threatening wounds
will receive the same care, the civilian follow-up care — or
lack thereof — could kill them.
Capt. Eric Departo, a nurse with the 399th Combat
Support Hospital, works in the ICU monitoring a
5-year-old Iraqi child who was shot in the abdomen.
Mystery Pnuemonia Toll May be much higher
Mark Benjamin
Published on Wednesday, September 17, 2003

WASHINGTON -- Mysterious pneumonia-like illnesses
and breathing problems appear to be striking U.S.
troops in greater numbers than the military has
identified in an investigation -- including more deaths,
according to soldiers and their families.
Soldiers can experience a wide variety of exposures to
pathogens from explosives or combat (wound infections)
or in health-care settings (nosocomial infections).
Trends in casualty rates in modern US military warfare
indicate rising wounded-to-killed ratios in the most
recent wars (Department of Defense, 2005). Military
personnel who might have been killed in an earlier era
may now live to be hospitalized because of the use of
body armor, better helmets, and more rapid emergency
care. These soldiers with serious wounds can carry
organisms of environmental origin (for example, from
soil or water) into the hospital setting. Organisms of
environmental origin that are prevalent in wound
infections can colonize fomites and be transmitted to
others via hospital personnel.

Nosocomial infections in military hospitals may have
different microbial profiles from those in civilian
hospitals in that they represent soil or water organisms
prevalent in wounds suffered in explosions or combat.
Nosocomial organisms that are familiar in civilian
settings can
Strong Germ causes alarm among State Health

Because there are two other organisms,
pseudomonas and acinetobacter, Murphy said are a
"bigger threat" than MRSA, he wants a broader
reporting plan instituted by the state health

"The CDC (Centers for Disease Control and
Prevention) should sit down, look at it and decide what
kind of national surveillance is appropriate," he said. "I
think it's important to refocus on resistance as
opposed to a specific organism."
Review of Quality Care
James A Haley Medical Center
Tampa Florida

Final report on the death of Jonathan
He was treated with meropenum and
vancomycin upon arrival at the field
baumannii in Iraq
Photo by Wired Magazine
Hospitals are
ditching infected
patients nursing
homes to die

Report Ditching

The Wars Come


Acinetobacter FAQ's

Report Cases of
Acinetobacter baumannii
A Cautionary
Report  2006
infection while
Given the reported low
serum tigecycline levels,
we urge caution when
using this drug for
treatment of A.
baumannii bloodstream