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Technical Documents and References

Bacterial Infections

Neumann, C., & Chukwuma, U. (2015). Early-onset Infectious Complications among Penetrating and Severe Closed Traumatic Brain Injury in Active Duty Deployed diring OIF and OEF, 2008-2013. Portsmouth: Navy and Marine Corps Public Health Center.

Abstract: Medical advances in addition to improved body armor during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) have greatly increased the chance of survival especially among deployment related severe closed and penetrating traumatic brain injury (TBI). However, early medical complications resulting from secondary brain injury play an important role in severe TBI patient outcomes and future survival. Early-onset infectious complications that occurred at a Level IV military treatment facility (MTF) were evaluated among active duty service members that sustained a TBI while deployed during OEF and OIF from calendar years 2008 to 2013. As a group, 14.0% of severe closed and penetrating TBI patients had at least one diagnosis indicating an early-onset infectious complication, most commonly pneumonia followed by systemic infection. However, closed TBI patients developed a greater proportion of early-onset infectious complications compared to penetrating TBI patients. Of infections caused by multidrug-resistant organisms (MDROs), MDR Acinetobacter and MRSA were the predominate pathogens. MDRO infections have the potential to further complicate the care of TBI patients.

Landrum, M. L., Neumann, C., Cook, C., Chukwuma, U., Ellis, M. W., Hospenthal, D. R., & Murray, C. K. (2012). Epidemiology of Staphylococcus aureus Blood and Skin and Soft Tissue Infections in the US Military Health System, 2005-2010. Journal of the American Medical Assoication, 308, No. 1, 50-59.

Epidemiology of Staphylococcus aureus Blood and Skin and Soft Tissue Infections in the US Military Health System, 2005-2010

Abstract: Rates of hospital-onset methicillin-resistant Staphylococcus aureus (MRSA) infections are reported as decreasing, but recent rates of community-onset S aureus infections are less known. To characterize the overall and annual incidence rates of community-onset and hospital-onset S aureus bacteremia and skin and soft tissue infections (SSTIs) in a national health care system and to evaluate trends in the incidence rates of S aureus bacteremia and SSTIs and the proportion due to MRSA. Observational study of all Department of Defense TRICARE beneficiaries from January 2005 through December 2010. Medical record databases were used to identify and classify all annual first-positive S aureus blood and wound or abscess cultures as methicillin-susceptible S aureus or MRSA, and as community-onset or hospital-onset infections (isolates collected 3 days after hospital admission). Unadjusted incidence rates per 100 000 person-years of observation, the proportion of infections that was due to MRSA, and annual trends for 2005 through 2010 (examined using the Spearman rank correlation test or the Mantel-Haenszel X2 test for linear trend). During 56 million person-years (nonactive duty: 47 million person-years; active duty: 9 million person-years), there were 2643 blood and 80 281 wound or abscess annual first-positive S aureus cultures. Annual incidence rates varied from 3.6 to 6.0per100 000 person-years for S aureus bacteremia and 122.7 to 168.9 per 100 000 person-years for S aureus SSTIs. The annual incidence rates for community-onset MRSA bacteremia decreased from 1.7 per 100 000 person-years (95% CI, 1.5-2.0 per 100 000 person-years) in 2005 to1.2per100 000person-years (95%CI,0.9-1.4per100 000person-years)in2010(P=.005 for trend). The annual incidence rates for hospital-onset MRSA bacteremia also decreased from 0.7 per 100 000 person-years (95% CI, 0.6-0.9 per 100 000 person-years) in 2005 to0.4per100 000person-years (95%CI,0.3-0.5per100 000person-years)in2010(P=.005 for trend). Concurrently, the proportion of community-onset SSTI due to MRSA peaked at 62% in 2006 before decreasing annually to 52% in 2010 (P .001 for trend). In the Department of Defense population consisting of men and women of all ages from across the United States, the rates of both community-onset and hospital-onset MRSA bacteremia decreased in parallel, while the proportion of community-onset SSTIs due to MRSA has more recently declined.

McAuliffe, K., Chukwuma, U., & Riegodedios, A. (2014). Description of bacterial respiratory
infections among Department of Defense beneficiaries, utilizing electronic clinical laboratory data, October 2008-September 2013.
Portsmouth: Navy and Marine Corps Public Health Center.

Abstract: Respiratory illness is a constant threat for military personnel due to crowded and stressful occupational conditions.1 Respiratory infections are among the leading causes of ambulatory visits and hospitalizations for active duty service members. It is also one of the leading causes of ambulatory clinic visits and absenteeism from work and school in the United States (US).2,3 This study used electronic clinical laboratory data to describe bacterial respiratory infections from October 2008 to September 2013, among all Department of Defense (DOD) beneficiaries seeking care within the Military Health System (MHS). Data were analyzed by fiscal year (FY), October 01 through September 30. Upper respiratory infections (URIs) displayed seasonal trends, occurring more frequently in fall and winter months. URIs occurred more frequently in the first two years of the study period (FY 2009 and FY 2010) than in the last three years of the study period. Lower respiratory infections (LRIs) declined since 2008 and lacked seasonal trends. Overall, URIs and LRIs declined by 36% and 23%, respectively, from FY 2009 to FY 2013. Additionally, there were significant changes in the demographic and clinical characteristics of URIs and LRIs. Beneficiaries 5-17 years of age were consistently most impacted by URIs, whereas those 45 years of age and older had the highest rates of LRIs. Periodic monitoring contributes to risk reduction by tracking trends and identifying populations that exceed baseline, which may help to mitigate increased risk of morbidity and mortality, given the occupational realities of DOD personnel.