Acinetobacter Baumannii infections

[old medic]

http://www.ctv.ca/servlet/ArticleNews/story/CTVNews/20090820/soldiers_bacteria_090820/20090820?hub=Canada

3 Canadian soldiers hospitalized with bacteria

Updated Thu. Aug. 20 2009 6:49 AM ET

The Canadian Press

QUEBEC -- Three Canadian soldiers infected with a bacteria are under quarantine at a Quebec City hospital.

A hospital spokeswoman says the soldiers returned from Afghanistan last Friday.

Genevieve Dupuis says they stayed at the military hospital in Kandahar before arriving in Quebec City.

She says two civilian patients staying near the soldiers at the Quebec City hospital have also been isolated due to concern they may have caught the bacteria.

Dupuis says Acinetobacter Baumannii usually invades wounds and is commonly found in hospitals that treat wounded soldiers.

She says around 15 soldiers have returned to Quebec City with the bacteria since 2007.

 

[PMedMoe]

More info on Acinetobacter infections from the CDC.

 

[dapaterson]

To my knowledge there have been quarantine measures in place for some prior casualties who were repatriated; are we failing to share lessons learned?

 

[old medic]

This one is good reading, and CFHS specific.

Acinetobacter Infections in Wounded Soldiers: Implications for Canadian Hospitals
Major Anthony Battad, Major Bruce Kropelin, Major Homer Tien
Wound Care Canada
Volume 5, Number 2, 2007
pages 16-18

http://www.cawc.net/open/wcc/5-2/battad.pdf

In January 2006, the authors were deployed
to the Canadian-led Multinational Hospital
in Kandahar, Afghanistan. During this
deployment, it was noticed that casualties requiring
mechanical ventilation frequently developed pneumonia.
Although the hospital did not have microbiological
testing capability, it was later found that many of the
Canadian patients were either colonized or infected with
Acinetobacter..............

 

[dapaterson]

Interesting article.  So, if we've been aware of this potential pathogen since 2006 (at least), where was the breakdown in communication that may have permitted two civilian patients to become infected?

 

[GAP]

If I remember correctly this was a concern in early 2006.

There was an article about the hospital in Germany keeping injured soldiers longer because they were infected with this bacteria, which apparently is in the soil everywhere in Afghanistan.

 

[Blackadder1916]

. . . So, if we've been aware of this potential pathogen since 2006 (at least), where was the breakdown in communication that may have permitted two civilian patients to become infected?

I wouldn't be assuming that there is any breakdown in communication (intentional or otherwise) between military health authorities and civilian medical facilities.  The potential of A. Baumannii being introduced into a facility by patients returning from Afghanistan is nothing new nor anything hidden from the wider medical community.  There was probably just a breach of infection control protocols within the hospital (could be as simple as someone not washing hands long enough).  Nosocomial infections are more common than most would like to admit (or at least publicize), and probably this only became a news story because of the unique circumstances of the bug's origin.  If the infection control staff had followed army.ca they would have been aware of A.Baumannii's potential.

http://forums.army.ca/forums/threads/23593/post-345551.html#msg345551

http://forums.army.ca/forums/threads/68908.0.html

I thought there had been another thread on this means with a more focused discussion of A. Baumannii but I haven't been able to find it.  Perhaps it was on another site that I visited back when the above stories came up.

 

[MedCorps]

Not all that long ago (Dec) I was asked to write a briefing note on Acinetobacter calcoaceticus-baumannii complex (ABC).

Here are some of the references if you are interested in reading more about ABC from a military medicine POV.

Aronson NE, Sanders JW, Moran KA. In harm’s way: infections in deployed American military forces. Clinical Infectious Diseases. 2006; 43:1045-1051.

Yun HC, Murray CK, Roop SA, et al. Bacteria recovered from patients admitted to a deployed U.S. military hospital in Baghdad, Iraq. Military Medicine. 2006; 171:821-825.

Griffith ME, Ceremuga J, Ellis MW, et al. Acinetobacter skin colonization in US Army Soldiers. Infection Control and Hospital Epidemiology. 2006; 27:659-661.

Griffith ME, Lazarus DR, Mann PB, et al. Acinetobacter skin carriage among US Army soldiers deployed in Iraq. Infection Control and Hospital Epidemiology. 2007; 28:720-722.

Scott P, Deye G, Srinivasan A, et al. An outbreak of multi-drug resistant Acinetobacter baumannii-calcoaceticus complex infections in the U.S. military health-care system associated
with military operations in Iraq. Clinical Infectious Diseases. 2007; 44:1577-1584.

MC

 

[RHFC_piper]

If I remember correctly this was a concern in early 2006.

There was an article about the hospital in Germany keeping injured soldiers longer because they were infected with this bacteria, which apparently is in the soil everywhere in Afghanistan.

I don't know about soldiers being kept in Germany longer for this reason (I can neither confirm nor deny, as I don't know), but this was a serious concern when I got to Sunnybrook.  All of the injured were quarantined immediately. Guests were required to don gowns, masks, gloves, and headwear before entering the room, and wash up with anti-bacterial soap before leaving.
As well, our wounds were swabbed and tested regularly (at least mine were… which really hurt as my wounds were really deep.)

There was probably just a breach of infection control protocols within the hospital. 

This would probably be, more so, the case; as much as guests were policed with regards to “gowning up”, some of the hospital staff weren’t.  Food services and cleaning staff would come and go in and out of the room without donning PPE, as did the doctors and specialists.  It seemed as though the only people who actually followed the protocol were the nurses and our guests.

To make matters worse, as much as our guests were required to gown up when they came in the room, there was nothing stopping them from putting us in a wheelchair and taking us to a common room without having us don any kind of protective gear... and by nothing stopping us, I mean no one even tried to stop us or told us otherwise.
My roommate there would even have his guests wheel him down to the front of the hospital so that he could have a smoke… and no one said a word.
Both of our families complained about the protocol, yet nothing was done about it.
Sooo.. it’s okay to move us through a hospital, specifically the trauma ward and into public areas, yet our family and the nurses, had to “gown up” for fear of spreading an infection?  This made very little sense to me (and yes, formal complaints have been made.)

Either way, this article contains no surprises.

 

[Blackadder1916]

I can't speak to the isolation "quarantine" procedures at Sunnybrook but what you described seems relatively common in my (somewhat dated) experience and 'generally' in line with accepted guidelines for "contact isolation".

While you and the other injured soldiers may have had the 'potential' to be pools of infection for others, it is generally those who have "physical contact" with you that are most at risk (or can pass the bug to others).  Support staff (cleaners, food svc, etc), while they may enter your room, do not usually touch you and if "contact" isolation protocols are in place should be further briefed about avoiding physical contact.  Doctors (what can I say), though they may occasionally actually touch an in-patient, physical contact on the ward is usually minimal and often does not have the potential for "soiling"; plus you can always tell a doctor, but you can't tell him much!.

The ones that did gown and glove when in contact with you, the nurses and visitors, are the ones who have the most (and sometimes only) physical contact with in-patients.  The nurses do it because they move frequently between patients; your visitors are made to do it because they could touch you and then touch themselves or others, or take the bug home on their hands or clothing.  I would be concerned that the wheelchair may be used for other patients, but that is usually handled by restricting use of that specific item to the isolated patient during his stay and maintaining a strict schedule of periodic and terminal cleaning.

Though it seems a little unusual to be permitted to leave your room when in "isolation", I could see it happening.  My assumption would be that the staff probably thought that there was a low risk of you directly contaminating other patients and mostly likely took into account that the pyschological aspects/problems of being in isolation could be compounded when the patients were recently wounded war veterans.

 

[Armymedic]

Interesting article.  So, if we've been aware of this potential pathogen since 2006 (at least), where was the breakdown in communication that may have permitted two civilian patients to become infected?

Not as likely a breakdown in comms, as it was a breakdown in infectious control. While everyone may remember to glove and gown, not everyone remembers to wash their hands between patients, or to wipe down their stethoscopes or penlights.

 

[The Bread Guy]

An update from Wired.com's Danger Room blog:

.... a Pentagon-funded research team at the University of Massachusetts Amherst, along with small biotech firm PolyMedix, are making rapid strides toward a new line of Iraqibacter treatments — and the medications could spur the development of antibiotics that can fend off other drug-resistant ailments.

“We didn’t set out to create a mechanism that could be applied to other illnesses,” Dr. Gregory Tew, the UMass scientist behind the project, told Danger Room. “But it’s an impressive and exciting bonus that’s come of our work.”

The scientists have already used the new type of antibiotics to effectively treat Staph infections, which kill thousands of Americans each year. Common antibiotics work by attaching to a specific molecule (like an enzyme) inside bacterial cells. With some minor adaptive changes, bacteria can alter their cell structure to prevent antibiotic binding, thereby becoming resistant to the drugs. Some infections even develop “persister cells,” which stop growing when the antibiotics are administered, and then turn back on once a round of meds is completed.

But Tew and co. have developed antibiotics that work from the outside to quickly destroy bacterial cells. The drugs work by poking holes in bacterial membranes, killing the cells instantly. Within a few hours, the antibiotics are able to kill off entire colonies of bacterial pathogens. And resistance is futile: because the meds don’t enter the actual cell, it’s impossible for the bacteria to fight back via structural adaptation.

The method has already proven effective in clinical trials for treating staph infections, and the Pentagon is betting it’ll be effective in combating Iraqibacter too. In 2009 alone, they doled out nearly $8 million to UMass and PolyMedix, to “study its antibiotic compounds for other biodefense applications and bacterial infections.”

Right now, the group is starting animal studies of Iraqibacter antibiotics, though Tew anticipates that human application is several years off. The scientists are also involved in preliminary research on using the membrane-puncture method to address other strains of bacteria ....