The Iraq Infection

Matthew Herper:

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.

Acinetobacter was the second most prevalent infection for soldiers in Vietnam, but the military did not expect to see it as part of Operation Iraqi Freedom. Researchers are still working to understand where it came from and how patients were infected.

Doctors worry not only about soldiers who are already infected but also those who are carrying Acinetobacter on their skin even though they themselves are not infected. Lt. Cmdr. Kyle Petersen, an infectious disease specialist at National Naval Medical Center (NNMC) in Bethesda, Md.,says his hospital treated 396 patients who had been wounded in Iraq between May 2003 and February 2005. About 10% were infected and another 20% were found to have Acinetobacter bacteria on their skin but were not infected. The rate of appearance of the bacteria has "been flat-out steady," says Petersen.

The same has been true at Army hospitals that include Walter Reed Medical Center in Washington, D.C., Tripler Medical Center inHawaii and Brooke Army Medical Center in San Antonio, where there has been a total of about 240 cases of patients infected, while another 500 have carried the bacteria, according to Col. Bruno Petrucelli, director of epidemiology and disease surveillance for the U.S. Army Center for Health Promotion and Preventive Medicine.

Petrucelli says the five patients who died were at Army hospitals—most of them at Walter Reed. They were already suffering from serious health problems before they contracted the bacteria. "These were the sickest of the sick," says Petrucelli. The infections are split evenly among wound infections, respiratory infections and a mix of bloodstream and other infections.

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."

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