Table 2.
Characteristics of Inpatient Infections among Wounded Military Personnel after Transfer to a United States Military Treatment Facility (2009 – 2013)1
| Afghanistan Theater | Iraq Theater | |||||
|---|---|---|---|---|---|---|
|
Noncombat Injury (N=180) |
Combat-related Injury (N=2138) |
Total (N=2318) |
Noncombat Injury (N=63) |
Combat-related Injury (N=132) |
Total (N=195) |
|
| Total Days of Patient Observations, No. | 3138 | 71,410 | 74,548 | 1043 | 4131 | 5174 |
| Unique Infections, No. | 30 | 1973 | 2003 | 21 | 82 | 103 |
| Infections per 100 person-days, No. (95% CI) | 1.0 (0.6–1.4) | 2.8 (2.6–2.9) | 2.7 (2.6–2.8) | 2.0 (1.2–3.1) | 2.0 (1.6–2.5) | 2.0 (1.6–2.4) |
| Patients admitted initially to LRMC ICU2 | 1.4 (0.8–2.3) | 3.7 (3.5–3.9) | 3.6 (3.5–3.8) | 4.1 (2.4–6.7) | 2.6 (2.1–3.3) | 2.8 (2.3–3.5) |
| Patients admitted initially to LRMC Ward2 | 0.7 (0.4–1.2) | 0.7 (0.6–0.8) | 0.7 (0.6–0.8) | 0.8 (0.2–1.8) | 0.8 (0.4–1.4) | 0.8 (0.4–1.2) |
| Incidence density rate ratio (95% CI): Combat versus Noncombat3 | NA | NA | 2.9 (2.0–4.3) | NA | NA | 0.99 (0.6–1.7) |
| Incidence density rate ratio (95% CI): LRMC ICU versus Ward4 | 2.0 (0.9–4.6) | 5.1 (4.3–6.0) | 5.0 (4.3–5.9) | 5.4 (1.9–18.9) | 3.5 (1.8–7.3) | 3.7 (2.2–6.8) |
| Patients with ≥1 infection, No. (%) | 24 (13) | 774 (36) | 798 (34) | 13 (21) | 41 (31) | 54 (28) |
| Infections per patient, No. (%)5 | ||||||
| 1 event | 20 (83.3) | 339 (43.8) | 359 (45.0) | 6 (46.2) | 17 (41.5) | 23 (42.6) |
| 2 events | 3 (12.5) | 174 (22.5) | 177 (22.2) | 6 (46.2) | 14 (34.1) | 20 (37.0) |
| 3 events | 0 | 97 (12.5) | 97 (12.2) | 1 (7.7) | 5 (12.2) | 6 (11.1) |
| ≥ 4 events | 1 (4.2) | 164 (21.2) | 165 (20.7) | 0 | 5 (12.2) | 5 (9.3) |
| Level of care location for infection, No. (%)5 | ||||||
| LRMC only | 5 (20.8) | 84 (10.9) | 89 (11.2) | 3 (23.1) | 6 (14.6) | 9 (16.7) |
| U.S. MTF only | 19 (79.2) | 536 (69.3) | 555 (69.5) | 7 (53.8) | 29 (70.7) | 36 (66.7) |
| Both LRMC and U.S. MTF | 0 | 154 (19.9) | 154 (19.3) | 3 (23.1) | 6 (14.6) | 9 (16.7) |
| Type of Infection, No. (%)6 | ||||||
| Skin and soft-tissue infections (SSTI) | 14 (46.7) | 918 (46.5) | 932 (46.5) | 5 (23.8) | 18 (22.0) | 23 (22.3) |
| Pneumonia | 7 (23.3) | 273 (13.8) | 280 (14.0) | 6 (28.6) | 17 (20.7) | 23 (22.3) |
| Bloodstream infection | 3 (10.0) | 276 (14.0) | 279 (13.9) | 4 (19.1) | 13 (15.9) | 17 (16.5) |
| Sepsis (excluding SIRS) | 0 | 86 (4.4) | 86 (4.3) | 1 (4.8) | 2 (2.4) | 3 (2.9) |
| Osteomyelitis | 2 (6.7) | 121 (6.1) | 123 (6.1) | 0 | 17 (10.7) | 17 (16.5) |
CI – Confidence Interval; ICU – intensive care unit; LRMC – Landstuhl Regional Medical Center; MTF – military treatment facility; NA – Not applicable; SIRS – systemic inflammatory response system
Data are restricted to patients who transferred to a participating U.S. MTF following treatment at Landstuhl Regional Medical Center.
Total number of patients initially admitted to LRMC ICU was 1195 for Afghanistan (combat: 1152; noncombat: 43) and 88 for Iraq (combat: 69; noncombat: 19). Total number of patients initially admitted to LRMC ward was 1118 for Afghanistan (combat: 982; noncombat 136) and 107 for Iraq (combat: 63; noncombat: 44).
p-value for incidence density rate ratio of combat versus noncombat for Afghanistan and Iraq was <0.0001 and 1.0, respectively
p-value for incidence density rate ratio of LRMC ICU versus ward for Afghanistan was <0.0001 (combat: <0.0001; noncombat: 0.083) and for Iraq was <0.0001 (combat: <0.0001; noncombat: <0.001).
The total number of patients with ≥1 infection was used to calculate percent. P-values comparing the combat and noncombat data from Afghanistan and Iraq were 0.001 and 0.722 for infections per subject, respectively, and 0.010 and 0.448 for location of infection, respectively.
The total number of unique infections was used to calculate percent. Does not include miscellaneous infections, such as sinusitis, central nervous system infections, and urinary tract infections.