American troops wounded in Iraq and brought back to military hospitals in the United States have unexpectedly high rates of infection with a drug-resistant type of bacteria, doctors are finding. The bacteria, Acinetobacter baumannii, are not unique to Iraq. They live in soil and water in many parts of the world, and had already been known to cause trouble in hospitals and on battlefields in Vietnam. They can invade wounds, the bloodstream, bones, the lungs and other parts of the body. Antibiotics can cure the infection, but doctors must use the right ones, which include amikacin and imipenem.
"It is not difficult to treat," said Col. Bruno Petruccelli, a physician and director of epidemiology and disease surveillance for the United States Army Center for Health Promotion and Preventive Medicine. "If the antibiotic works, it works easily. It easily dies." But, he added, an especially resistant strain of bacteria can cause a prolonged infection. About 240 cases have been treated at Army hospitals since 2003, Colonel Petruccelli said. Hospitals like Walter Reed now see 6 to 12 infected soldiers a month; before 2003 they had no more than one a month.
An online publication, Forbes.com, described the current outbreak on Tuesday, and reported that about 40 infected patients had been treated at the National Naval Medical Center in Bethesda, Md., in the same time period. A spokesman for the hospital did not respond to telephone messages on Wednesday.
No American soldiers from the Iraq war have died from the bacteria, but five very ill patients in the same hospitals as wounded soldiers became infected in the hospital and subsequently died. It is not known whether the bacteria or the patients' underlying illnesses caused their deaths, Colonel Petruccelli said. He said healthy people can harbor the bacteria on their skin for a long time, and may spread them to others. Doctors can infect patients if they fail to wash their hands and clean stethoscopes and blood pressure cuffs after treating infected people. Patients who are chronically ill or have weakened immune systems are especially vulnerable to the infection.
The bacteria pose a challenge because they have natural defenses that let them fight off many antibiotics, and they are also good at improvising ways to outfox new drugs that are thrown at them, said Dr. Arjun Srinivasan, a medical epidemiologist with the Centers for Disease Control and Prevention. In addition, he said, they are extremely hardy, and in one experiment proved capable of living on surfaces for up to 20 days. That makes them a menace in hospital rooms, where they can lurk on bed rails, tables and other furnishings and infect one patient after another unless every item in the room is thoroughly disinfected.
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http://www.nytimes.com/2005/08/04/national/04germ.html?
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