Army hospitals in the U.S. are struggling to contain a bacterial outbreak that has already affected some 280 soldiers who have either returned from Iraq themselves or who have come in contact with returning soldiers.
The bacteria, Acinetobacter, which also posed a problem during the Vietnam War is resistant to many drugs and spreads easily, posing a problem for military hospitals which treat a large number of patients who have just returned from overseas.
The majority of the current victims of Acinetobacter are young troops who were injured by land mines, mortars, and suicide bombs. However, five deaths occurred in already sick patients at the Walter Reed Medical Center in Washington D.C. who contracted the bacteria from returning soldiers being treated there.
Doctors did not anticipate that the bacteria would be a concern during Operation Iraqi Freedom and researchers do not know yet how soldiers initially became infected. But now, Arjun Srinivasan, a Lieutenant Commander in the United States Public Health Service and a medical epidemiologist at the Centers for Disease Control and Prevention describes this as “a very large outbreak."
According to one doctor at National Naval Medical Center (NNMC) in Bethesda, Maryland, of the 396 patients who had been wounded in Iraq and were treated between May 2003 and February 2005 about 10% were found to be infected with the bacteria. An additional 20% were carrying Acinetobacter bacteria on their skin but were not infected.
Other army hospitals have been facing similar problems. Walter Reed Medical Center, the Tripler Medical Center in Hawaii, and the Brooke Army Medical Center in San Antonio, have reported a total of 240 infected patients and another 500 carrying the bacteria.
In order to prevent infections from spreading, hospitals are requiring doctors and nurses to wear gloves and gowns when coming in contact with returning patients who are being quarantined until their cultures, swabbed from the groin or armpit, test negative.
In order to be as careful as possible over the past 18 months, all new patients are assumed to be positive until they are confirmed to be negative. Infected patients are being kept in clusters of rooms away from those who are not infected.
The types of infections that Acinetobacter causes include wound, respiratory, and bloodstream infections. While wound infections can be treated using the intravenous antibiotic imipenem, infections of the bone and internal organs are more dangerous and difficult to treat since only three antibiotics are effective against the bacteria.
In addition to imipenem, which can cause seizures, amikacin can be used; however it does not work for bone infections and some strains of the bacteria are resistant to it. The third option was colistin; however doctors have stopped using it because it is harmful to the kidney.
Dealing with outbreak has been costly for the NNMC. The annual bill for the necessary antibiotics has increased ten times to $200,000. The cost of gowns and gloves to prevent contamination has risen 80% to 12,000.