Genesis of Clinical Microbiology in the CSH - Afghanistan 2002 LTC John M. Scherer

UNCLASSIFIEDLTC John M. Scherer/(301) 619-8837/[email protected] 1 March 2010

Genesis of Clinical MicrobiologyGenesis of Clinical Microbiologyin the CSH - Afghanistan 2002in the CSH - Afghanistan 2002

LTC John M. SchererLTC John M. Scherer Ph.D., M.T. (ASCP)Ph.D., M.T. (ASCP)


HISTORY

• May 2002 • Outbreak of unknown illness among British soldiers• Unknown etiology• Critically ill• Spreading person-to-person

• 44th MEDCOM responsible for HCO• Currently no CSH in Afghanistan• Concern over inability to ID any infectious diseases• 520th TAML had the capability but not all the components• Three-person team deployed July 2002 met up with 339th CSH in August


MISSION

To deploy the developmental M403 Microbiology Augmentation Set to Bagram Air Force Base in Afghanistan, work out supply issues, train the 339th CSH in its use, and redeploy back to COUNS for future deployment to Kuwait.


CAPABILITIES

• Culture: Wounds, Blood, Stools, Urine, Respiratory, Fluids, etc.

• Antibiotic Susceptibilities: GNR & GPC (- Strep pneumo)

• RAPID tests: Group A Strep, Influenza, Strep pneumo, some Protozoa

• O&P

• Direct Fungal Staining

• Malaria Staining


• Mycobacterium staining or culture

• Anaerobe identification

• Fungal identification

ITEMS NOT PART OF THE KIT





Isolates and Susceptibility Patterns


Coagulase test



Specimen Local National US/Coalition Total

Sputum 58 2 60

Wound 108 23 131

Stool 5 79 84

Blood 108 15 123

Urine 67 36 103

STD 4 27 31

Throat/Nasal 2 35 37

CSF 12 8 20

O&P 4 56 60

Total 368 281 649

Demographics of Microbiology Workload 452nd Combat Support Hospital, Bagram Afghanistan

(April 1, 2003 to Mar 15, 2004)


Top Organisms isolated*E. coli 30K. pneumoniae 19A. baumannii 17E. cloacae 16Staph not aureus 16P. aeruginosa 11Shigella sp 10S. aureus 10Klebsiella other 8Enterobacter aerogenes 8Proteus sp 6Haemophilus sp 5Total 156

Most commonly isolated organisms from 452nd Combat Support Hospital, Bagram Afghanistan

(April 1, 2003 to Mar 15, 2004).

*These 12 organisms account for approximately 85% of the total number of positive cultures.


Source Organism Number PositiveBlood Enterobacter aerogenes 5

Acinetobacter baumannii

3

Sputum Acinetobacter baumannii

10

Klebsiella pneumoniae 6Stool Shigella species 9Urine E. coli 14

Klebsiella pneumoniae 5Enterobacter cloacae 5

Wound E. coli 12Enterobacter cloacae 9Staphylococcus aureus 8

Most common isolated organisms based on culture type 452nd Combat Support Hospital, Bagram Afghanistan

(April 1, 2003 to Mar 15, 2004).

UNCLASSIFIEDLTC John M. Scherer/(301) 619-8837/[email protected] 1 March 2010Slide 15

Afghanistan USE. coli 43% 4%

K. pneumoniae 79% 12%/21%

E. cloacae 75% 43%*/75% *Enterobacter species

P. aeruginosa 55% 23%/55%

ESBL activity as measured by Ceftazidime resistance

Annals of Clinical Microbiology and Antimicrobials 2004; 3:7 Journal of Antimicrobial Chemotherapy 2000; 45: 295-303

UNCLASSIFIEDLTC John M. Scherer/(301) 619-8837/[email protected] 1 March 2010Slide 16

Afghanistan US

Ampicillin 7% 52%/60%

Cephalothin 20% 62%/70%

Ciprofloxacin 60% 87%/96%

Nitrofurantoin 80% 98%

SXT 37% 75%/81%

E. Coli Susceptibility Pattern

Annals of Clinical Microbiology and Antimicrobials 2004; 3:7 Antimicrobial Agents and Chemotherapy 2001; 1402–1406


• Overall, the set performed exceptionally well

• Susceptibility patterns are different than those observed in the US

• Some tests will not provide the same performance as they do in the US

• Gram negative rods were frequently isolated from blast wounds (not Acinetobacter)

CLINICAL CONCLUSIONS


• Maintain soldiers with local knowledge in theater • Decreases casualty movement/decreased logistical burden • Mission readiness

- Bacterial versus viral meningitis

IMPACT BEYOND PATIENT CARE


Questions

Special Thanks to CPT Scott Cvecko for the data from the 452nd CSH

Documents

Genesis of Clinical Microbiology in the CSH - Afghanistan 2002 LTC John M. Scherer