Volume 11, Number 8—August 2005
Research
Multidrug-Resistant Acinetobacter Extremity Infections in Soldiers
Kepler A. Davis*
, Kimberly A. Moran†, C. Kenneth McAllister*, and Paula J. Gray*
, Kimberly A. Moran†, C. Kenneth McAllister*, and Paula J. Gray*Table 1
Acinetobacter osteomyelitis*
| Patient | Osteomyelitis location | Mechanism of injury | MDR isolate | Bacteremia | Hardware | Parenteral drug therapy | Follow on oral antimicrobial agents | Recurrent infection | Follow-up, wk† |
|---|---|---|---|---|---|---|---|---|---|
| 1 | Left radius/ulna | Landmine explosion, driver of pavement grater | Yes | No | Yes | Imipenem 500 mg every 6 h, amikacin 20 mg/kg/d for 8 wk | No | Secondary infection with MSSA | 12 |
| 2 | Right humerus/shoulder | IED round through shoulder | Yes | No | Yes | Imipenem 500 mg every 6 h, amikacin 15 mg/kg/d for 6 wk | Yes, ciprofloxacin 500 mg 2 × a day | No | 32 |
| 3 | Right humerus/shoulder | IED blast, shrapnel injury | Yes | No | Yes | Imipenem 500 mg every 6 h, amikacin 15 mg/kg/d for 7 wk | No | No | 35 |
| 4 | Left radius/ulna | Gunner in APC who received RPG blast | Yes | Yes | No | Imipenem 500 mg every 6 h for 7 wk, with amikacin 20 mg/kg/d for 3 wk changed to amp/sulb 3 g every 6 h for 4 wk | No | No | 4 |
| 5 | Left tibia | Mortar blast, shrapnel injuries | Yes | No | No | Ceftazidime 2 g every 8 h; amikacin 12.5 mg/kg/d for 7 wk | No | No | 7 |
| 6 | Right distal humerus/elbow | Passenger in HMMWV, roadside IED blast | Yes | No | Yes | Imipenem 500 mg every 6 h for 7 wk | No | Secondary infection with Enterobacter cloacae | 22 |
| 7 | Left tibia/fibula | Proximate IED blast | Yes | No | Yes | Amp/sulb 12 g continuous 24-h infusion for 6 wk | No | No | 36 |
| 8 | Left humerus | Proximate mortar round blast | Yes | Yes | No | Meropenem 1 g every 8 h for 7 wk | No | No | 5 |
| 9 | Left tibia/fibula | Driver of Humvee, hit land mine | Yes | No | No | Gentamicin 5 mg/kg/d for 3 wk | No | No | 40 |
| 10 | Left distal humerus/elbow | Truck driver, IED blast | Yes | No | Yes | Imipenem 500 mg every 6 h for 6 wk | No | Yes—secondary pin tract infection, No culture | 30 |
| 11 | Right humerus/shoulder | Gunner in HMMWV, IED blast | Yes | No | No | None | No | No | 39 |
| 12 | Right humerus/elbow | HMMWV passenger, IED blast | No | No | Yes | Imipenem 500 mg every 6 h, amikacin 15 mg/kg/d for 6 wk | No | Secondary infection with MRSA | 48 |
| 13 | Left tibia | 50-caliber gunshot wound | No | No | No | Amp/sulb 3 g every 6 h, amikacin 20 mg/kg/d for 6 wk | Yes—amox/clav 875/125 mg 2 ×/d for 3 wk | Secondary infection with MSSA | 61 |
| 14 | Left humerus/elbow | Motor vehicle accident, elbow out window, no blast injury | No | No | Yes | Imipenem 500 mg every 6 h, gentamicin 5 mg/kg/d for 4 d | Yes—levofloxacin 500 mg/d for 10 d | No | 57 |
| 15 | Right femur | Passenger HMMWV, RPG round to right leg | No | Yes | No | Imipenem 500 mg every 6 h, amikacin 20 mg/kg/d for 6 wk | No | No | 9 |
| 16 | Left tibia | Gunshot wound to left leg | No | No | No | Imipenem 500 mg every 6 h, amikacin 15 mg/kg/d for 8 wk | No | No | 35 |
| 17 | Right tibia/fibula | Passenger HMMWV, IED blast, open fracture | No | No | No | Imipenem 500 mg every 6 h for 4 wk, followed by meropenem 1 g every 8 h for 2 more wk | No | Secondary infection with MRSA | 50 |
| 18 | Left tibia | Motor vehicle accident, run over by tank | No | No | No | Ceftazidime 2 g every 8 h for 4 wk | No | No | 56 |
*MDR, multidrug resistant; MSSA, methicillin-sensitive Staphylococcus aureus; IED, improvised explosive device; APC, armored personnel carrier; RPG, rocket-propelled grenade; HMMWV, high mobility multipurpose wheeled vehicle, also known as Humvee; MRSA, methicillin-resistant S. aureus; Amp/sulb, ampicillin/sulbactam; Amox/clav, Amoxicillin + clavulanic acid.
†Length of follow-up after completion of antimicrobial drug therapy.
