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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)
UNCLASSIFIEDLTC John M. Scherer/(301) 619-8837/[email protected] 1 March 2010
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
UNCLASSIFIEDLTC John M. Scherer/(301) 619-8837/[email protected] 1 March 2010
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.
UNCLASSIFIEDLTC John M. Scherer/(301) 619-8837/[email protected] 1 March 2010
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
UNCLASSIFIEDLTC John M. Scherer/(301) 619-8837/[email protected] 1 March 2010
• Mycobacterium staining or culture
• Anaerobe identification
• Fungal identification
ITEMS NOT PART OF THE KIT
UNCLASSIFIEDLTC John M. Scherer/(301) 619-8837/[email protected] 1 March 2010
UNCLASSIFIEDLTC John M. Scherer/(301) 619-8837/[email protected] 1 March 2010
UNCLASSIFIEDLTC John M. Scherer/(301) 619-8837/[email protected] 1 March 2010
UNCLASSIFIEDLTC John M. Scherer/(301) 619-8837/[email protected] 1 March 2010
Isolates and Susceptibility Patterns
UNCLASSIFIEDLTC John M. Scherer/(301) 619-8837/[email protected] 1 March 2010
UNCLASSIFIEDLTC John M. Scherer/(301) 619-8837/[email protected] 1 March 2010
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)
UNCLASSIFIEDLTC John M. Scherer/(301) 619-8837/[email protected] 1 March 2010
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.
UNCLASSIFIEDLTC John M. Scherer/(301) 619-8837/[email protected] 1 March 2010
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
UNCLASSIFIEDLTC John M. Scherer/(301) 619-8837/[email protected] 1 March 2010
• 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
UNCLASSIFIEDLTC John M. Scherer/(301) 619-8837/[email protected] 1 March 2010
• Maintain soldiers with local knowledge in theater • Decreases casualty movement/decreased logistical burden • Mission readiness
- Bacterial versus viral meningitis
IMPACT BEYOND PATIENT CARE
UNCLASSIFIEDLTC John M. Scherer/(301) 619-8837/[email protected] 1 March 2010
Questions
Special Thanks to CPT Scott Cvecko for the data from the 452nd CSH