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Healthcare-associated pneumonia among U.S. combat casualties, 2009 to 2010.

Publication Status: Published

Sponsoring Organization: Army

Sponsoring Office: Uniformed Services University of Health Sciences

Congressionally Mandated: No

Funding Source: Agency, office or organization under authority of the Sec Def (not affiliated to Army, Navy, or Air Force)

Release Date/Publication: January 01, 2015

Principle Investigator Status: Government

Primary DoD Data Source: Other Clinical

Secondary DoD Data Source:


Although there is literature evaluating infectious complications associated with combat-related injuries from Iraq and Afghanistan, none have evaluated pneumonia specifically. Therefore, we assessed a series of pneumonia cases among wounded military personnel admitted to Landstuhl Regional Medical Center, and then evacuated further to participating U.S. military hospitals. Of the 423 casualties evacuated to the United States, 36 developed pneumonia (8.5%) and 30 of these (83.3%) were ventilator-associated. Restricting to 162 subjects admitted to intensive care, 30 patients had pneumonia (18.5%). The median Injury Severity Score was higher among subjects with pneumonia (23.0 vs. 6.0; p < 0.01). There were 61 first-isolate respiratory specimens recovered from 31 pneumonia subjects, of which 56.1% were gram-negative, 18.2% were gram-positive, and 18.2% were fungal. Staphylococcus aureus and Pseudomonas aeruginosa were most commonly recovered (10.6%, and 9.1%, respectively). Thirteen bacterial isolates (26.5%) were multidrug-resistant. Outcome data were available for 32 patients, of which 26 resolved their infection without progression, 5 resolved after initial progression, and 1 died. Overall, combat-injured casualties suffer a relatively high rate of pneumonia, particularly those requiring mechanical ventilation. Although gram-negative pathogens were common, S. aureus was most frequently isolated. Continued focus on pneumonia prevention strategies is necessary for improving combat care.

Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.


Yun HC, et al. Infectious Disease Clinical Research Program Trauma Infectious Disease Outcomes Study Group. Healthcare-associated pneumonia among U.S. combat casualties, 2009 to 2010. Mil Med. 2015 Jan;180(1):104-10.

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