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Comparison of Carbapenem-Resistant Microbial Pathogens in Combat and Non-combat Wounds of Military and Civilian Patients Seen at a Tertiary Military Hospital, Philippines (2013-2017).
Velasco, John Mark; Valderama, Ma Theresa; Margulieux, Katie; Diones, Paula Corazon; Peacock, Trent; Navarro, Fatima Claire; Liao, Cynthia; Chua, Domingo; Macareo, Louis; Crawford, John; Swierczewski, Brett.
Afiliación
  • Velasco JM; Department of Virology, U.S. Army Medical Directorate - Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand 10400.
  • Valderama MT; University of the Philippines Manila, Ermita, Manila, Philippines 1000.
  • Margulieux K; Department of Virology, U.S. Army Medical Directorate - Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand 10400.
  • Diones PC; Department of Bacterial and Parasitic Diseases, U.S. Army Medical Directorate - Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand 10400.
  • Peacock T; Department of Virology, U.S. Army Medical Directorate - Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand 10400.
  • Navarro FC; Department of Bacterial and Parasitic Diseases, U.S. Army Medical Directorate - Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand 10400.
  • Liao C; V Luna Medical Center, Armed Forces of the Philippines Health Service Command, V Luna Ave., Quezon City, Philippines 0840.
  • Chua D; V Luna Medical Center, Armed Forces of the Philippines Health Service Command, V Luna Ave., Quezon City, Philippines 0840.
  • Macareo L; V Luna Medical Center, Armed Forces of the Philippines Health Service Command, V Luna Ave., Quezon City, Philippines 0840.
  • Crawford J; Department of Virology, U.S. Army Medical Directorate - Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand 10400.
  • Swierczewski B; University of the Philippines Manila, Ermita, Manila, Philippines 1000.
Mil Med ; 185(1-2): e197-e202, 2020 02 12.
Article en En | MEDLINE | ID: mdl-31247085
INTRODUCTION: Bacterial wound infections are a danger to both military and civilian populations. The nature of injury and infection associated with combat related wounds are important in guiding antibiotic prophylaxis and empiric treatment guidelines. MATERIALS AND METHODS: The isolates were screened for drug-resistance by the MicroScan Walkaway Plus System using either the Negative Breakpoint Combo Panel (NBCP) 30 or 34 or Positive Breakpoint Combo Panel (PBPC) 20 or 23. Isolates with a minimum inhibitory concentration (MIC) of ≥8 µg/mL to imipenem and/or meropenem were tested for both carbapenemase production using the CarbaNP test and real-time PCR to determine molecular resistance mechanisms. Plasmid conjugation analysis was performed to define potential for horizontal gene transfer. RESULTS: We characterized 634 bacterial wound isolates collected from September 2013 to December 2017 from patients seen at a Philippine military tertiary hospital presenting with combat or non-combat injuries [354 (military) and 280 (civilians)]. Staphylococcus aureus was the most predominant bacterial species isolated from wounds in both populations (104/634, 16%). A variety of Gram-negative bacterial species comprised 442/634 (70%) of the isolates identified, with the most prevalent shown to be Pseudomonas aeruginosa, Enterobacter cloacae, Klebsiella pneumoniae, Escherichia coli, and Acinetobacter sp. Carbapenemase production was detected in 34/442 (8%) Gram-negative isolates. Testing for molecular resistance mechanisms showed 32/34 (17 military, 15 civilian) wound isolates were blaNDM positive and 2 were blaVIM positive, with the two blaVIM isolates found in the civilian population. Plasmid conjugation of 14 blaNDM and 2 blaVIM positive wound isolates representatives showed 2/16 (13%) produced E. coli J53 transconjugants (E. coli from a civilian; E. cloacae from a military). CONCLUSION: We describe in this study the wound bacterial and antibiotic resistance profile in the military (combat vs non-combat associated) and civilian population. We observed that, with the exception of Acinetobacter sp., resistance of prevalent Gram-negative bacterial species to imipenem or meropenem were not significantly different between the military and civilian populations. We also presented data on the prevalent bacterial species isolated from both combat and non-combat wounds in a military tertiary care hospital setting as well as the carbapenemase-encoding gene primarily responsible for carbapenem resistance as well as evidence of horizontal transfer via mobile genetic elements. Clinicians may use this information to guide empiric antibiotic coverage for the predominant organisms if wound culture results are not readily available.A prospective, longitudinal evaluation of the wound bacterial profile documenting the changing bacterial flora using higher resolution molecular strategies can provide a more comprehensive understanding of the diversity, composition, and abundance of bacterial composition of the wound microbial community from the time of injury, during the course of evacuation from the field to higher level of care facilities, and up to wound resolution.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Personal Militar Tipo de estudio: Guideline / Observational_studies / Risk_factors_studies Límite: Humans País/Región como asunto: America do norte / Asia Idioma: En Revista: Mil Med Año: 2020 Tipo del documento: Article Pais de publicación: Reino Unido

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Personal Militar Tipo de estudio: Guideline / Observational_studies / Risk_factors_studies Límite: Humans País/Región como asunto: America do norte / Asia Idioma: En Revista: Mil Med Año: 2020 Tipo del documento: Article Pais de publicación: Reino Unido