Wired's Write-up on Acinetobacter

The MRSA of the military hospital, MDR-AB, is finally getting some media attention. Here's Wired News's article:

"A homemade bomb exploded under a Humvee in Anbar province, Iraq, on August 21, 2004. The blast flipped the vehicle into the air, killing two US marines and wounding another - a soft-spoken 20-year-old named Jonathan Gadsden who was near the end of his second tour of duty. In previous wars, he would have died within hours. His skull and ribs were fractured, his neck was broken, his back was badly burned, and his stomach had been perforated by shrapnel and debris.

Gadsden got out of the war zone alive because of the Department of Defense's network of frontline trauma care and rapid air transport known as the evacuation chain. Minutes after the attack, a helicopter touched down in the desert. Combat medics stanched the marine's bleeding, inflated his collapsed lung, and eased his pain. He was airlifted to the 31st Combat Support Hospital in Baghdad, located in an old health care facility called the Ibn Sina, which had formerly catered to the Baathist elite. Army surgeons there repaired Gadsden's cranium, removed his injured spleen, and pumped him full of broad-spectrum antibiotics to ward off infection.

Three days later, he was flown to the Landstuhl Regional Medical Center in Germany, the largest American military hospital in Europe. He was treated for his burns, and his spine was stabilized for the 18-hour flight to the US. Just a week after nearly dying in the desert, Gadsden was recuperating at the National Naval Medical Center in Bethesda, Maryland, with his mother, Zeada, at his bedside.

The surgeons, nurses, medics, and pilots of the evacuation chain have saved thousands of lives. Soldiers wounded in Vietnam were six weeks of transit time away from US hospitals, and one out of every four of them died. By contrast, a soldier's odds of surviving battle injuries in Iraq are nine out of 10. Unfortunately, this remarkable advance in battlefield logistics has also resulted in an increase in the number of traumatically injured patients who are particularly susceptible to infections during their recovery. In Gadsden's case, from the moment he was carried into the Ibn Sina, the injured marine was in the crosshairs of an enemy he didn't even know was there.

At first, he did quite well. By early September, Gadsden was weaned off his ventilator and breathing on his own. For weeks he gradually improved. His buddies took him to a Washington Redskins game in his wheelchair, and the next day he navigated 50 feet with a walker. Soon Gadsden was transferred to a veterans' hospital in Florida called the James A. Haley Medical Center, where he offered to serve as the eyes of a fellow marine blinded in an ambush. The doctors told Zeada that her son might be able to go home by the end of October.

But he still had mysterious symptoms that he couldn't shake, like headaches, rashes, and intermittent fevers. His doctors gave him CT scans, laxatives, methadone, beta-blockers, Xanax, more surgery, and more antibiotics. An accurate evaluation of his case was difficult, however, because portions of his medical records never arrived from Bethesda. If they had, they would have shown a positive test for a kind of bacteria called Acinetobacter baumannii.

In the taxonomy of bad bugs, acinetobacter is classified as an opportunistic pathogen. Healthy people can carry the bacteria on their skin with no ill effects - a process known as colonization. But in newborns, the elderly, burn victims, patients with depressed immune systems, and those on ventilators, acinetobacter infections can kill. The removal of Gadsden's spleen and the traumatic nature of his wounds made him a prime target.

On October 17, the marine was given a day pass to accompany his mother to Wal-Mart, where he bought her a purse. Hours after returning to the hospital, his condition deteriorated abruptly. His heart rate and blood pressure were elevated, and his white blood cell count was spiking. Nurses noted in his chart that he had become "disoriented to place, time, and people - thinking he is at home - sitting up thinks he's lying down." He struggled through occupational therapy the following morning, shivering and complaining of the cold.

Gadsden had a seizure and a heart attack the next day. The neurology team discovered that his cerebrum and cerebellum had swelled up overnight; he was clinically brain-dead. His family and minister were called to the hospital, and on October 22 he was taken off life support.

The Marine Corps public affairs office sent out the customary press release attributing Gadsden's death to "injuries as a result of enemy action." But then a few weeks later, Zeada's dentist told her a Florida newspaper was reporting that her son had died of bacterial meningitis. Aided by US representative Bill Young, Zeada - who works as a cardiac-care technician in South Carolina - demanded an investigation.

She discovered that an autopsy was performed shortly after her son's death. The coroner recorded the "manner of death" as "homicide (explosion during war operation)" but determined the actual cause of death to be a bacterial infection. The organism that killed Gadsden, called Nocardia, had clogged the blood vessels leading to his brain. But the acinetobacter had been steadily draining his vital resources when he could least afford it. For weeks, it had been flourishing in his body, undetected by the doctors at Haley, resisting a constant assault by the most potent antibiotics in the medical arsenal.

"No one said that my son had anything like that," Zeada says. "I never had to wear gloves or a mask, and none of the nurses did either. No one had any information."

Since OPERATION Iraqi Freedom began in 2003, more than 700 US soldiers have been infected or colonized with Acinetobacter baumannii. A significant number of additional cases have been found in the Canadian and British armed forces, and among wounded Iraqi civilians. The Armed Forces Institute of Pathology has recorded seven deaths caused by the bacteria in US hospitals along the evacuation chain. Four were unlucky civilians who picked up the bug at Walter Reed Army Medical Center in Washington, DC, while undergoing treatment for other life-threatening conditions. Another was a 63-year-old woman, also chronically ill, who shared a ward at Landstuhl with infected coalition troops.

Behind the scenes, the spread of a pathogen that targets wounded GIs has triggered broad reforms in both combat medical care and the Pentagon's networks for tracking bacterial threats within the ranks. Interviews with current and former military physicians, recent articles in medical journals, and internal reports reveal that the Department of Defense has been waging a secret war within the larger mission in Iraq and Afghanistan - a war against antibiotic-resistant pathogens.

Acinetobacter is only one of many bacterial nemeses prowling around in ICUs and neonatal units in hospitals all over the world. A particularly fierce organism known as MRSA - methicillin-resistant Staphylococcus aureus - infects healthy people, spreads easily, and accounts for many of the 90,000 fatal infections picked up in US hospitals each year. Another drug-resistant germ on the rise in health care facilities, Clostridium difficile, moves in for the kill when long courses of antibiotics have wiped out normal intestinal flora.

Forerunners of the bug causing the military infections have been making deadly incursions into civilian hospitals for more than a decade. In the early 1990s, 1,400 people were infected or colonized at a single facility in Spain. A few years later, particularly virulent strains of the bacteria spread through three Israeli hospitals, killing half of the infected patients. Death by acinetobacter can take many forms: catastrophic fevers, pneumonia, meningitis, infections of the spine, and sepsis of the blood. Patients who survive face longer hospital stays, more surgery, and severe complications.

Nevertheless, the bug makes an unlikely candidate for the next mass plague. It preys exclusively on the weakest of the weak and the sickest of the sick, slipping into the body through open wounds, catheters, and breathing tubes. Colonization poses no threat to people who aren't already ill, but colonized health care workers and hospital visitors can carry the bacteria into neighboring wards and other medical facilities. Epidemiologist Roberta Carey at the Centers for Disease Control and Prevention calls acinetobacter the Rodney Dangerfield of microorganisms: "It doesn't get a lot of respect because it's not out there bumping off normal, healthy people." But lately the bacteria has been getting its due, because it is rapidly evolving resistance to all of the antibiotics that used to keep it in check."

-----------------------------------------------------

There's a lot more in the story, so check it out, I don't really want to post the full thing here as it is rather long. Army screw-ups and poor medical communication and care lead to the death of a many young veterans who would have otherwise lived a long and healthy life.

The US Army is purposely keeping this story buried, as it does reflect rather poorly on them. Fortunately people are beginning to hear about it. It was brand new info to me about three months ago, but the situation has been going on since 2003.