RESUMEN
Skin and soft tissue infections (SSTIs), including those caused by methicillin-resistant Staphylococcus aureus (MRSA), are common in military training environments. In 2014, the healthcare providers for trainees at Joint Base San Antonio (JBSA)-Lackland, TX, notified the surveillance unit of increased antibiotic resistance reported on wound cultures of purulent SSTIs. To provide updated clinical guidance to local providers, the surveillance unit conducted a review of all SSTIs diagnosed among trainees at JBSA-Lackland between 1 October 2012 and 31 December 2014. SSTI cumulative incidence during the surveillance period was 0.81%, with similar rates between males (0.80%) and females (0.84%) and between basic (0.82%) and technical (0.79%) trainees. Of 772 total cases, 254 were cultured; 196 resulted in growth of one or more pathogens: MRSA (n=110); methicillin-sensitive S. aureus (n=68); other gram-positive cocci (n=5); and gram-negative rods (n=18). In vitro activity of commonly used antibiotics against S. aureus isolates dropped slightly from the previous surveillance period. In addition to novel antibiotic research and development, these trends warrant enhanced local preventive efforts and close adherence to evidence-based treatment algorithms.
Asunto(s)
Antibacterianos/uso terapéutico , Personal Militar , Enfermedades Cutáneas Infecciosas , Infecciones de los Tejidos Blandos , Infecciones Comunitarias Adquiridas/tratamiento farmacológico , Infecciones Comunitarias Adquiridas/epidemiología , Infecciones Comunitarias Adquiridas/microbiología , Femenino , Humanos , Incidencia , Masculino , Vigilancia de la Población , Enfermedades Cutáneas Infecciosas/tratamiento farmacológico , Enfermedades Cutáneas Infecciosas/epidemiología , Enfermedades Cutáneas Infecciosas/microbiología , Infecciones de los Tejidos Blandos/tratamiento farmacológico , Infecciones de los Tejidos Blandos/epidemiología , Infecciones de los Tejidos Blandos/microbiología , Texas/epidemiologíaRESUMEN
BACKGROUND: Adenovirus serotype 14 (Ad-14) recently emerged as a respiratory pathogen in the United States, with studies suggesting higher morbidity and mortality. This study was conducted to determine whether Ad-14 is associated with clinical outcomes in otherwise healthy patients with pneumonia. METHODS: Medical records of military trainees hospitalized with pneumonia during an outbreak of Ad-14 infection were reviewed. Clinical, radiographic, and laboratory parameters were compared on the basis of Ad-14 infection. RESULTS: Two hundred thirty-four trainees received a diagnosis of pneumonia, and 83(35%) were hospitalized. Sixty-one percent of patients with pneumonia were Ad-14 positive; 43% of patients with Ad-14 pneumonia were hospitalized (83% of female patients and 40% of male patients; P = .04), compared with 40% of patients with Ad-14 negative cases. Ad-14 infection was associated with higher admission temperature (38.3°C [interquartile range, (IQR) 37.7, 39.4] vs 37.3°C [IQR (36.7, 38.5)]; P < .01) and lower white blood cell count (8.3 × 1000 cells/µL [IQR, 5.7, 12.4] vs 13 × 1000 cells/µL [IQR, 7.5, 12.9]; P = .01), neutrophil count (6.7 × 1000 cells/µL [IQR, 2.8, 9.7] vs 9.7 × 1000 cells/µL [IQR, 5.6, 12.1]; P = .02), lymphocyte count (0.9 × 1000 cells/µL [IQR, 0.8, 1.1] vs 1.3 × 1000 cells/µL [IQR, 1, 1.9]; P = .001), and platelet count (210 × 1000 cells/µL [IQR, 145, 285] vs 261 × 1000 cells/µL [IQR, 238, 343]; P < .01). Ad-14 pneumonia was not associated with specific radiographic findings, pneumonia severity score, intensive care unit admission, longer hospitalization, or 30-day mortality. CONCLUSIONS: During an outbreak of Ad-14 infection, Ad-14 infection was not associated with excess overall morbidity or mortality. Ad-14 infection was associated with specific laboratory and clinical parameters and higher hospitalization rates in female trainees. These data provide new insight to the epidemiology of Ad-14 infection.
Asunto(s)
Infecciones por Adenoviridae/virología , Adenoviridae/clasificación , Personal Militar , Neumonía Viral/virología , Infecciones por Adenoviridae/epidemiología , Infecciones por Adenoviridae/patología , Adolescente , Brotes de Enfermedades , Femenino , Humanos , Masculino , Neumonía Viral/epidemiología , Neumonía Viral/patología , Estudios Retrospectivos , Estados Unidos/epidemiología , Adulto JovenRESUMEN
The Air Force makes an extraordinary effort to prevent heat-related illnesses associated with basic military training (BMT) in south Texas. However, inadequate hydration can still contribute to lost training time and qualified trainees leaving military service without completing BMT. The purpose of the present study was to determine whether equipping BMTs with back-mounted hydration systems (BM) is better than the standard-issue (SI) canteens with respect to hydration status. Male BMTs were randomly assigned to either BM (n = 40) or SI (n = 38) groups. Baseline values were assessed at week 0 before any physical readiness training (PRT). Subsequent data collection took place in the a.m. before PRT and in the p.m. before dinner the first 3 weeks, and during the 5 weeks of training. BMT total body water (TBW) and body composition were assessed by bioelectrical impedance. Saliva osmolality and total protein concentration were also determined. Hydration status increased daily in BM and SI and was well maintained over the duration of BMT. A significant hydration effect (p < 0.05) was observed for average daily increases in TBW and body weight with BM gaining more compared to SI. Average a.m. TBW was 0.3-0.8 L greater in SI versus BM (p < 0.05). Our findings demonstrate that adequate hydration status is maintained during Air Force BMT in a hot environment using either hydration mode and therefore do not support widespread issuance of the BM system on the premise of improved hydration during USAF BMT military training.