TABLE II.

Future Directions and Considerations in Combat Trauma-Related Infection Research

Future directions
	Evaluation of long-term consequences: incident diagnoses (not limited to infections), healthcare utilization, and costs Re-assessment of infection risk and outcomes following surgical/medical care, applying improved injury/wound and microbiologic classifications Relative impact of specific surgical and antimicrobial therapy on outcomes Prolonged field care and the impact on early onset infections, particularly high-consequence infections, such as IFIs and sepsis Clinical decision support tools for triage and diagnostic support downrange to risk stratify casualties based on likelihood of developing high-consequence infections to aid in prioritization of medevac, resuscitative care, and en-route care
Future considerations
	Next-generation DoDTR and ID module Direct connection to existing Military Health System electronic data to lessen abstraction requirement and increase critical data availability and timeliness Refine ID module to support near real-time infection/wound microbiology surveillance, combat-related infection syndrome surveillance, and priority outcome metrics to support accelerated generation of evidence to inform practice change and respond to emerging threats
	Contingency planning Best evidence to support wound infection prevention and treatment requires well-designed randomized controlled trials. Optimal to initiate during periods between wars in best comparable civilian trauma settings “On-the-shelf” contingency protocol(s) for future conflicts that could be used to conduct interventional trials during wartime with prioritized research questions addressing gaps Wartime serum/tissue repository framework with accompanying regulatory guidance to support development and deployment of biomarkers for prognostic, diagnostic, and therapeutic monitoring purposes Interoperable approaches to wartime wound infection surveillance developed through collaboration with ally country partners

Abbreviations: DoDTR—Department of Defense Trauma Registry; ID—infectious disease; IFI—invasive fungal wound infection.