Afghan Patients a Common Source of Drug-Resistant Bacteria

Afghan patients treated at a U.S. military hospital in Afghanistan often carry multidrug-resistant (MDR) bacteria, according to a report in the September issue of Infection Control and Hospital Epidemiology. The findings underscore the need for effective infection control measures at deployed hospitals where both soldiers and local patients are treated, the study's authors say.

The research team, led by Air Force Lt. Col. Deena Sutter of the San Antonio Military Medical Center, studied U.S. and Afghan patients admitted to the military hospital at Bagram Air Base over a one-year period. Of 1071 Afghans receiving care, 113 had MDR bacteria. In contrast, only 14 of 765 U.S. personnel were found to have MDR bacteria.

The high rate of MDR bacteria among Afghans is partly due to the fact that they generally stay in the hospital longer than U.S. personnel, who are usually discharged or moved stateside within a few days. Longer hospital stays are often associated with higher risk of acquiring MDR bacteria. However, the study found that a surprising number of Afghan patients already had MDR bacteria when they arrived at the hospital. Of the positive cultures taken from patients whose bacteria were considered community-acquired, more than 58 percent contained MDR bacteria.

Of additional concern is that most of the bacteria recovered from Afghan patients were Gram-negative, which are known to cause especially hard-to-treat infections.

As part of the mission in Afghanistan, U.S. military hospitals often treat Afghan troops and local non-combatants who are injured in combat operations. Care is also provided to other civilians as space and resources permit.

"The rates of recovery of [Gram-negative and MDR bacteria] in the local Afghan population cared for at our facility were quite high, exceeding those of civilian patients reported from the Iraqi combat theater," the researchers write. Treating a local population with a high baseline rate of MDR colonization alongside U.S. personnel "makes the practice of good infection control essential," the researchers conclude.

Reference: Deena E. Sutter, Linda U. Bradshaw, Lucas H. Simkins, Amy M. Summers, Michael Atha, Robert L. Elwood, Janelle L. Robertson, Clinton K. Murray, Glenn W. Wortmann, Duane R. Hospenthal, "High Incidence of Multidrug-Resistant Gram-Negative Bacteria Recovered from Afghan Patients at a Deployed US Military Hospital" Infection Control and Hospital Epidemiology 32:9.

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