But this superbug continues to present myriad challenges for field hospitals where the bacteria easily grow and cross-contaminate other patients and test results are often slower than the rate of treatment and transfer. Combat support hospitals and longer-term tertiary care hospitals like Landstuhl in Germany may not know for several days or weeks that a patient has acquired an acinetobacter infection. With the speed of the transfer along the transport chain, constant vigilance is required.
“My concern is that we have a Level I trauma center that spreads out 8,500 miles,” Hospenthal said. “In our system, when you get injured you get transferred and handed off many, many, many times and you get transported across long distances and that just increases the opportunity for nosocomial transmission or cross contamination, so I think we always have to be worried about that.”
For soldiers injured in Afghanistan or Iraq, the evacuation process takes them through an emergency room that spans several continents.
Acinetobacter has infected more than 3,300 U.S. injured troops in military hospitals, between 2003, when it was first recognized as a problem, and 2009, the last time the Department of Defense made statistics public. However, these statistics only include wounded service members who happen to have been tested for the bacteria. At various points of acinetobacter outbreak during that period, observed rates were as high as 20 percent of wounded soldiers in military hospitals.
The Oversight Committee of the House Armed Service Committee called a hearing to discuss multidrug resistant bacteria, especially acinetobacter, and their role in the military healthcare system last fall. The 112th Congress chose not revisit the issue. Military-based research funding for superbugs was decreased from $14 million in 2010 to $2 million in 2011. The Department of Defense did not request additional funds and Congress did not allocate any. Some research on acinetobacter continues through other programs like Brooke Army Medical Center’s burn studies. But, the NIH, not the Department of Defense, now oversees funding for most acinetobacter studies and those dollars could be in danger due to budget cuts made in the recent debt-ceiling agreement.
Creeping into civilian hospitals?
With the withdrawal of 33,000 troops from Afghanistan over the next year and the majority of the 50,000 troops from Iraq by the end of this year, there are questions about how infections in the military hospitals might affect the U.S. healthcare system. The non-profit group Institute of Federal Health Care concluded in June 2009, “Gram-negative infections [including acinetobacter] constitute a threat to health care facilities in the U.S. from returning troops, posing issues of how much followup is feasible, for how long and at what cost?” The remarks were part of a round table discussion called “Emerging Infectious Diseases In-Theater: Risks and Mitigation,” with more than two-dozen military and private health care representatives.
But doctors interviewed for this piece, both military and civilian, are unsure if there’s any reason for concern. “There were other non-deployed very sick people in the ICUs at Walter Reed that did have very similar strains of acinetobacter, the implications being that they did get cross-contamination and probably infection from acinetobacter that was brought back by returning troops,” said Hospenthal, referring to a 2007 study at Walter Reed Medical Center. “Based on that I would say, yes, there’s a threat. Now, has that threat proven significant? I have not seen any data for that. We were certainly concerned that it would spread through the VA system.”
The Department of Veterans Affairs contends that its rates of acinetobacter are low when compared to civilian hospitals, with about 28,000 cases of acinetobacter last year out of 5.5 million veterans treated. Roughly 415,000 of that group were service members returning from Iraq or Afghanistan who did not have traumatic injuries and, thus, were less likely to have acinetobacter infections. Injured troops are, for the most part, still treated in the military healthcare system at Walter Reed Medical Center, National Naval Medical Center or Brooke Army Medical Center, so any acinetobacter infections they might have would be counted in the military’s numbers, not the VA hospitals’.