Superbugs and War

This is an important medical story about the spread of a drug-resistant strain of bacteria called Acinetobacter baumannii. The spread of this superbug - it's known as an opportunistic pathogen, since it preys on the old, young and weak - seems to largely be a consequence of war. Here's Steve Silberman of Wired:

The first news that US troops had engaged an unforeseen enemy in Iraq appeared on a physicians' email list called ProMED on April 17, 2003. A communicable-disease expert in the Navy named Kyle Petersen posted a request for information about unusual infections he was seeing aboard the USNS Comfort, a 1,000-bed hospital ship off the coast of Kuwait.

The Comfort was taking in 50 new patients a day by helicopter, many of them Iraqi civilians and prisoners of war. Petersen told the ProMED list that he had seen "several cases of [multidrug-resistant] acinetobacter amongst Iraqi natives wounded by gunshots, shrapnel, burns or motor vehicle accidents." Reviewing the literature, he found reports of an outbreak in Turkish hospitals after an earthquake in 1999, which suggested to him that "acinetobacter species are fairly common pathogens in traumatic wounds, especially if they are dirty." The bugs on the Comfort, however, were more resistant than the Turkish strains. He continued: "Can anyone familiar with the soil biology of Iraq or the drug prescribing practices of the pre-regime medical system explain the severe drug resistance pattern we are seeing among our trauma victims medevaced from Iraq" Any comments would be greatly appreciated."

The bug's emergence on the Comfort made a tough job even tougher. In infected burn victims, skin grafts failed. Two Iraqi patients died. Luckily, the acinetobacter on the Comfort was still susceptible to imipenem, one of the carbapenem-based "magic bullets" kept in reserve for the day when nothing else works. The staff quickly ran through its stock of the drug, firing off urgent requests for more. By isolating carriers in an area of the ship nicknamed Acinetobacter Alley and maxing out the imipenem, the medics finally brought the spread of the bacteria under control.

Soon, however, the bug started popping up in other hospitals along the evacuation chain. More than 70 patients at Walter Reed eventually contracted acinetobacter infections of the blood. Other infected patients and carriers surfaced at Landstuhl, Bethesda, and Balad Air Base, the embarkation point for troops on their way out of Iraq. By early 2005, nearly one-third of the wounded soldiers admitted to the National Naval Medical Center had been colonized by the bacteria. Only a handful of the early cases could be traced directly to the bugs on the Comfort, because the ship steamed out of the Gulf three months into the war. But almost all of the infected patients and carriers had received medical care at field hospitals in Iraq.

It now seems as if the scourge is spreading.

British health care officials are deeply concerned about a possible link between the civilian outbreaks and coalition troops carrying the bacteria home from Iraq. The UK's Health Protection Agency sent out a notice in 2003 asking doctors to submit samples of acinetobacter - from patients known to have returned from Iraq, or from patients on a ward where there have been Iraq returnees - to a lab for genotyping. Three months ago, a health official in England told The Independent that the same strain of bacteria infecting troops had been implicated in at least three civilian outbreaks. Prime minister Tony Blair recently announced that a major civilian hospital will open a ward just for military patients.