Map of life expectancy at birth from Global Education Project.

Tuesday, August 02, 2005

Bring 'em on

As U.S. military deaths in Iraq jumped past 1,800 today, I came across a story that reminds us of a much larger number that nobody is counting, that is the number of U.S. troops who are horribly injured and maimed. (Of course, far more Iraqis, by an order of magnitude, have suffered these fates.)

Nowadays, most medical news appears in the NYWT business section. By the same logic, this very strange story appears only here, on Why? Because it has to do with a potential market for antibiotics, just as all developments in public health are really about commerce.

The Iraq Infection
Matthew Herper, 08.02.05, 6:00 AM ET

Military doctors are fighting to contain an outbreak of a potentially deadly drug-resistant bacteria that apparently originated in the Iraqi soil. So far at least 280 people, mostly soldiers returning from the battlefield, have been infected, a number of whom contracted the illness while in U.S. military hospitals.

Most of the victims are relatively young troops who were injured by the land mines, mortars and suicide bombs that have permeated the Iraq conflict. No active-duty soldiers have died from the infections, but five extremely sick patients who were in the same hospitals as the injured soldiers have died after being infected with the bacteria, Acinetobacter baumannii.

"This a very large outbreak," says Arjun Srinivasan, a lieutenant commander in the U.S. public health service and a medical epidemiologist at the Centers for Disease Control.


Preventing the bacteria's spread has required doctors to take extreme care, putting all patients who are returning from the theater of war into isolation. "It's one of those pathogens that once it gets into a population and a chain of care, it can set up shop. Trying to contain the spread of this infection to other people is very difficult," says Andrew Shorr, a doctor who recently left Walter Reed for Washington Hospital Center. "What has happened over the past 18 months is every patient who shows up, we assume they're positive until they are demonstrated negative."

One of those infected in Iraq was Marine Cpl. Sean Locker. On July 10, he was attacked by a suicide bomber in a car while guarding a convoy. Shrapnel hit him in his nose, his right index finger and his right eye, blinding him. His left lung collapsed. But the worst damage was done to his left arm. It was amputated, and Locker says he knew it would be as soon as he looked down at it. "I tried to stay level-headed," he says.

Locker, 25, was flown to an army base in Landstuhl, Germany, and then to NNMC in Bethesda. There, doctors found that what was left of his arm after the amputation had been infected with Acinetobacter. For Locker, the prognosis was good, as two years of hard experience treating patients who had returned from war had taught doctors how to deal with the infection—and to prevent it from spreading to sicker patients. Using imipenem, one of three intravenous antibiotics effective against Acinetobacter, doctors are treating Locker's infection. He hopes to go home soon and buy a new truck.

But other patients have been less fortunate, as they have suffered from infections of the bone, the bloodstream or of internal organs, which have complicated their care. Lt. Cmdr. Petersen says that NNMC's annual bill for the kind of antibiotics Locker received has increased tenfold to $200,000.

What appears to be happening is that these horrific injuries allow whatever bacteria are around to enter the soldiers' bodies and get established. This exotic pathogen is then imported to U.S. military hospitals.

So-called nosocomial infections -- pathogens endemic to hospitals -- are already a big problem. Since they live in hospitals, they are of course drug resistant. In the U.S., the big ones include multi-drug resistant staphyloccus, and an intestinal infection called Clostridium dificil. (Having had it myself, puedo decirles, es muy difícil.) We certainly don't need another one.

As for other opinions I may have about this situation, I'll avoid repeating myself.

(BTW: No news on a diagnosis for YT, I'll let y'all know when I have something to report.)

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