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Volume 11, Number 8—August 2005

Research

Multidrug-Resistant Acinetobacter Extremity Infections in Soldiers

Kepler A. Davis*Comments to Author , Kimberly A. Moran†, C. Kenneth McAllister*, and Paula J. Gray*
Author affiliations: *Brooke Army Medical Center, Fort Sam Houston, Texas, USA; †Walter Reed Army Medical Center, Washington, DC, USA

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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.

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