1405Antimicrobial Susceptibility of Obligate Anaerobes Isolated from Military Trauma Patients

Abstract Background Biocides play an integral role in infection control. Paralleling concern about rising incidence of multidrug-resistant (MDR) organisms is a concern for resistance to biocides. In small studies, several genes involved in the production of efflux pump proteins have been identified as markers of biocide resistance in Klebsiella spp., namely cepA, qacA, qacE, qac∆E, and acrA. This study aimed to analyze the Klebsiella spp. isolates of a previously defined military trauma group with a high incidence of MDR organisms for the presence of these genes and their correlation with other resistance. Methods All infecting K. pneumoniae, K. variicola, and K. quasipneumoniae isolates archived by the Trauma Infectious Disease Outcomes Study (June 2009–December 2014) were selected. Additionally, all colonizing isolates linked with infecting isolates were included; the remainder to total 50 MDR and 46 non-MDR colonizing isolates were chosen randomly. Antimicrobial identification and susceptibilities were determined by CLSI criteria using the BD Phoenix Automated Microbiology System. PCR according to published methods for cepA, qacA, qacE, qac∆E, and acrA was accomplished in duplicate. MDR was defined as either resistance to ≥3 classes of aminoglycosides, β-lactams, carbapenems and/or fluoroquinolones or production of an ESBL or KPC. Results A total of 237 isolates (221 K. pneumoniae, 10 K. variicola, 6 K. quasipneumoniae) met inclusion criteria, of which 149 (63%) were MDR. All isolates had been exposed to antimicrobials prior to isolation. Of all isolates, 234 (98%) carried cepA: 218 (98%) K. pneumoniae carried cepA, 10 (100%) K. variicola carried cepA, and 6 (100%) of K. quasipneumoniae carried cepA. In addition, 148 (62%) isolates with cepA were MDR. One (10%) K. variicola isolate carried qacE along with cepA. This isolate was the only MDR K. variicola. None of the isolates carried qacA, qac∆E, or acrA. Conclusion We confirmed the near universal presence of the cepA biocide resistance gene in Klebsiella spp. isolated from trauma patients in Iraq and Afghanistan. In the largest evaluation of biocide resistance genes in Klebsiella spp. to our knowledge, the presence of qacA, qacE, qac∆E, and acrA was less common than has been reported elsewhere. Disclosures All authors: No reported disclosures.

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1442Clinical Epidemiology of Candida Colonization and Infection in Military Trauma Patients from Iraq and Afghanistan

Open Forum Infectious Diseases ◽

10.1093/ofid/ofu052.988 ◽

2014 ◽

Vol 1 (suppl_1) ◽

pp. S379-S380

Author(s):

Dana M. Blyth ◽

Amy C. Weintrob ◽

Katrin Mende ◽

Miriam L. Beckius ◽

Wendy C. Zera ◽

...

Keyword(s):

Trauma Patients ◽

Candida Colonization ◽

Military Trauma

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Antifungal Resistance Patterns in Molds Isolated from Wounds of Combat-Related Trauma Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.018 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S78-S79 ◽

Cited By ~ 1

Author(s):

Nicholas Keaton ◽

Katrin Mende ◽

Miriam Beckius ◽

Aaron Farmer ◽

Julie Rizzo ◽

...

Keyword(s):

Fungal Infections ◽

Medical Center ◽

Trauma Patients ◽

Broth Microdilution ◽

Fusarium Spp ◽

Post Injury ◽

Disease Outcomes ◽

Military Trauma ◽

Resistance Patterns ◽

Outcomes Study

Abstract Background An outbreak of trauma-related invasive fungal infections (IFI) occurred in US service members injured in Afghanistan. Empiric treatment included voriconazole (VORI) and amphotericin (AMB) and aggressive surgical debridement. Antifungal susceptibilities (AS) and relation to outcomes are yet to be described. Methods Between 2009 and 2013, military trauma patients with initial unique and serial (>3 days after initial isolation) molds isolated from wounds and admitted to Brooke Army Medical Center as part of the Trauma Infectious Disease Outcomes Study were assessed. The AS to AMB, VORI, posaconazole (POSA), isavuconazole (ISA), itraconazole, and caspofungin were determined by broth microdilution with CLSI breakpoint interpretations for Aspergillus spp. and mucormycetes (MM). Results Included are 18 patients with 28 initial mold isolates with 72% of IFI diagnosed via histopathology. All patients were male with a median of eight operations. There was a median of 11 days post-injury to mold culture. Initial isolates were five Aspergillus spp., three MM, three Fusarium spp., and combinations of three Aspergillus and MM, two Aspergillus and Fusarium, one Aspergillus and Bipolaris, one MM and Fusarium. A. flavus (AFL) and A. fumigatus (AFU) were all susceptible to AMB and POSA and 25% of AFL were intermediate to VORI. Four A. terreus (AT) isolates had MICs to AMB of 0.25, 1, 2, and 4, and were susceptible to VORI. ISA MIC50 and 90 were one and two for Aspergillus spp. Fusarium spp. MICs were >16 for VORI, POSA, and ISA, with AMB MIC50/90 of two and three. Among MM isolates, 86% were susceptible to AMB and 29% to POSA, and ISA MIC50 and MIC90 were 8 and >16. Five patients had serial isolates. One with serial AFL and AFU received no antifungal therapy, one with AT was treated with VORI, AMB, and POSA, and one with AFL was treated with AMB with no new resistance. The patient with serial MM was treated with AMB and VORI and remained resistant to POSA, but susceptible to AMB. Serial A. elegans acquired new POSA and AMB resistance and ISA MIC increased from 4 to 16 after AMB and VORI exposure. Conclusion Antifungal exposure to AMB and VORI was not associated with new resistance within Aspergillus spp., but 50% of MM exposed to this combination developed POSA and AMB resistance. Despite resistance of Fusarium, it was not isolated on subsequent debridements. Disclosures All authors: No reported disclosures.

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Trauma Embolic Scoring System in military trauma: a sensitive predictor of venous thromboembolism

Trauma Surgery & Acute Care Open ◽

10.1136/tsaco-2019-000367 ◽

2019 ◽

Vol 4 (1) ◽

pp. e000367 ◽

Cited By ~ 1

Author(s):

Patrick F Walker ◽

Seth Schobel ◽

Joseph D Caruso ◽

Carlos J Rodriguez ◽

Matthew J Bradley ◽

...

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

High Risk ◽

Scoring System ◽

Injury Severity ◽

Univariate Analysis ◽

Trauma Patients ◽

Military Trauma ◽

Support Tools ◽

Combat Casualties

IntroductionClinical decision support tools capable of predicting which patients are at highest risk for venous thromboembolism (VTE) can assist in guiding surveillance and prophylaxis decisions. The Trauma Embolic Scoring System (TESS) has been shown to model VTE risk in civilian trauma patients. No such support tools have yet been described in combat casualties, who have a high incidence of VTE. The purpose of this study was to evaluate the utility of TESS in predicting VTE in military trauma patients.MethodsA retrospective cohort study of 549 combat casualties from October 2010 to November 2012 admitted to a military treatment facility in the USA was performed. TESS scores were calculated through data obtained from the Department of Defense Trauma Registry and chart reviews. Univariate analysis and multivariate logistic regression were performed to evaluate risk factors for VTE. Receiver operating characteristic (ROC) curve analysis of TESS in military trauma patients was also performed.ResultsThe incidence of VTE was 21.7% (119/549). The median TESS for patients without VTE was 8 (IQR 4–9), and the median TESS for those with VTE was 10 (IQR 9–11). On multivariate analysis, Injury Severity Score (ISS) (OR 1.03, p=0.007), ventilator days (OR 1.05, p=0.02), and administration of tranexamic acid (TXA) (OR 1.89, p=0.03) were found to be independent risk factors for development of VTE. On ROC analysis, an optimal high-risk cut-off value for TESS was ≥7 with a sensitivity of 0.92 and a specificity of 0.53 (area under the curve 0.76, 95% CI 0.72 to 0.80, p<0.0001).ConclusionsWhen used to predict VTE in military trauma, TESS shows moderate discrimination and is well calibrated. An optimal high-risk cut-off value of ≥7 demonstrates high sensitivity in predicting VTE. In addition to ISS and ventilator days, TXA administration is an independent risk factor for VTE development.Level of evidenceLevel III.

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The use of retrievable inferior vena cava filters in severely injured military trauma patients

Journal of Vascular Surgery ◽

10.1016/j.jvs.2008.09.004 ◽

2009 ◽

Vol 49 (2) ◽

pp. 410-416 ◽

Cited By ~ 33

Author(s):

Owen N. Johnson ◽

David L. Gillespie ◽

Gilbert Aidinian ◽

Paul W. White ◽

Eric Adams ◽

...

Keyword(s):

Inferior Vena Cava ◽

Inferior Vena ◽

Vena Cava ◽

Trauma Patients ◽

Severely Injured ◽

Inferior Vena Cava Filters ◽

Vena Cava Filters ◽

Military Trauma

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1439Clinical Correlation between CLSI vs EUCAST Criteria of Candida Species in Military Trauma Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofu052.985 ◽

2014 ◽

Vol 1 (suppl_1) ◽

pp. S379-S379

Author(s):

Dana M. Blyth ◽

Katrin Mende ◽

Amy C. Weintrob ◽

Miriam L. Beckius ◽

Wendy C. Zera ◽

...

Keyword(s):

Candida Species ◽

Trauma Patients ◽

Military Trauma

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Outcomes of tranexamic acid administration in military trauma patients with intracranial hemorrhage: a cohort study

BMC Emergency Medicine ◽

10.1186/s12873-020-00335-w ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Patrick F. Walker ◽

Joseph D. Bozzay ◽

Luke R. Johnston ◽

Eric A. Elster ◽

Carlos J. Rodriguez ◽

...

Keyword(s):

Cohort Study ◽

Tranexamic Acid ◽

Intracranial Hemorrhage ◽

Trauma Patients ◽

Military Trauma ◽

Acid Administration

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Stenotrophomonas maltophilia Resistance in Military Trauma Patients

Open Forum Infectious Diseases ◽

10.1093/ofid/ofw172.191 ◽

2016 ◽

Vol 3 (suppl_1) ◽

Author(s):

Shane Patterson ◽

Katrin Mende ◽

Ping Li ◽

Dan Z. Lu ◽

Clinton K. Murray ◽

...

Keyword(s):

Stenotrophomonas Maltophilia ◽

Trauma Patients ◽

Military Trauma

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1184. Resistance Patterns and Susceptibility Analysis of Klebsiella pneumoniae Infections in Service Members Who Sustained Trauma in Iraq and Afghanistan

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1017 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S357-S358

Author(s):

John Kiley ◽

Katrin Mende ◽

Susan J Kaiser ◽

Leigh Carson ◽

Dan Z Lu ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Common Species ◽

Multidrug Resistant ◽

Trauma Patients ◽

Disease Outcomes ◽

Antibiotic Susceptibilities ◽

Military Trauma ◽

Resistance Patterns ◽

Outcomes Study ◽

Susceptibility And Resistance

Abstract Background Klebsiella pneumoniae was the third most common species of multidrug-resistant (MDR) Gram-negative organism in military trauma patients injured in Iraq and Afghanistan (2009–2014). This study aims to characterize the antimicrobial susceptibility and resistance patterns of K. pneumoniae isolates in these patients. Methods All infecting K. pneumoniae isolates (IKpI) archived by the Trauma Infectious Disease Outcomes Study (TIDOS) and 96 colonizing isolates (CKpI) from groin swabs were included (6/09-12/14). All CKpI linked with IKpI were included; the remainder to total 50 MDR and 46 non-MDR CKpI were chosen randomly. Antimicrobial identification and susceptibilities were determined by CLSI criteria using the BD Phoenix Automated Microbiology System. MDR was defined as either resistance to ≥3 classes of aminoglycosides, β-lactams, carbapenems, and/or fluoroquinolones or production of an ESBL or KPC. Results Of 588 K. pneumoniae archived isolates, 237 isolates were included in the analysis (141 IKpI and 96 CKpI). IKpI sources were 40% wound, 22% respiratory, 20% blood, 9% urine, and 9% other. Antibiotic susceptibilities for IKpI were: cefazolin (CFZ) 20%, ceftriaxone 30%, levofloxacin 62%, piperacillin–tazobactam (PTZ) 41%, meropenem 96%, and amikacin 89%. MDR IKpI and CKpI were more likely to have had prior fluoroquinolone (82% vs. 18%, P < 0.01) or anti-pseudomonal penicillin (53% vs. 47%, P < 0.01) exposure. Seventeen patients had CKpI cultured at a median of 5 days (IQR 2–17) before a subsequent IKpI with 11 (65%) having MDR CKpI. All IKpI isolated after MDR CKpI were also MDR. Among IKpI recovered after non-MDR CKpI, new resistance was noted in 1 IKpI to gentamicin (200 days post-CKpI), 1 IKpI to ertapenem (7 days post-CKpI), two IKpI to CFZ (10 days and 17 days, respectively), and 1 IKpI to PTZ (19 days post-CKpI). Serial isolates of IKpI had similar MDR status (63% initial IKpI were MDR, whereas 76% of subsequent IKpI were MDR). Conclusion K. pneumoniae isolates in military trauma patients from Iraq and Afghanistan had challenging resistance patterns. Prior exposure to fluoroquinolones and anti-pseudomonal penicillins were associated with MDR K. pneumoniae isolation. MDR status of CKpI predicted subsequent IKpI MDR status. Disclosures All authors: No reported disclosures.

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