THE IRAQIBACTER

BY MARGARET DAVIDSON

Staff Sgt. Nathan Reed was escorting a CBS news team through Baghdad for a Memorial Day visit in 2006 when the car bomb went off. Reed survived, but his right leg was severely injured. He was rushed to military hospitals in Iraq and Germany, then to Brooke Army Medical Center in San Antonio.

The injured leg developed an infection from a bacterium called acinetobacter baumannii. Reed had to decide whether or not to have his leg amputated. He consulted his doctors. He weighed his options. Finally, after getting all the information he could, he went ahead with the surgery. "The Iraqibacter pretty much sealed the fate for my amputation," he says.

The bacterium nicknamed the Iraqibacter is an increasingly multi-drug-resistant supergerm that is plaguing wounded soldiers who served in Iraq. The Infectious Diseases Society of America (IDSA) has put it on a short list of six dangerous, top-priority, drug-resistant microbes. Doctors are running out of ammunition to fight it.

The Iraqibacter joins on that list a better-known and more common supergerm, methicillin-resistant staphylococcus aureus (MRSA). Though less virulent than MRSA, acinetobacter baumannii is more drug-resistant. Not only does it possess a number of resistant genes itself, it also accepts resistant genes from other bacteria.

"I think it's unique," says Col. Glenn Wortmann, acting chief of infectious diseases at Walter Reed Army Medical Center, about the Iraqibacter's resistance, "and I think that's what has the IDSA so concerned."
Many infected soldiers respond to only a couple of different drugs. And Wortmann says he has encountered one or two isolated lab samples of the bacteria that were resistant to all antibiotics. "The issues with acinetobacter resistance are likely to continue to grow," predicts epidemiologist Arjun Srinivasan of the Centers for Disease Control and Prevention.

Acinetobacter (pronounced a-sin-EE-toe-back-ter) has quietly become a new cost of war in terms of the added time it takes infected soldiers to recover, the deaths of a few infected individuals, and the resources involved in treatment and prevention.

How widespread is the problem? Military and CDC representatives say they don't know because acinetobacter cases are not required to be reported.
Online bloggers accuse military officials of not being forthcoming about the extent of the problem. "They've done everything they can to play down the numbers," charges one of those bloggers, veteran activist Kirt Love, who is director of the Desert Storm Battle Registry.

One expert on the Iraqibacter, Maj. Clark K. Murray of Brooke Army Medical Center's Infectious Disease Service, disagrees. "We have published a large body of scientific work on the bacteria and have discussed with numerous media sources the impact of acinetobacter," he says.

Numbers are hard to pin down, but studies of U.S. military hospitals document a dramatic increase since the beginning of the war. For instance, at Brooke, 30 of the 151 injured soldiers from the Iraq and Afghanistan wars admitted to the hospital from March 1, 2003, to May 31, 2004, were infected with acinetobacter, up from only two infected soldiers seen there in the previous 14 months.

As case numbers surge, doctors face a declining number of treatment options because, Murray says, "the resistance of acinetobacter to antibiotics has increased over the war." Healthy individuals are at little risk, and young, physically fit soldiers are usually able to overcome the infection with the help of antimicrobial drugs that still work. But more vulnerable civilian patients in the same medical facilities have occasionally not been so lucky. Experts are divided as to what extent the Iraqibacter causes deaths. They say it is difficult to determine whether patients die as a result of the bacterial infection or from their underlying injuries or illnesses.

The bacteria can create a variety of problems, including pneumonia or meningitis and infections of the wounds, bloodstream, urinary tract or bones.

The source of the bacteria is a mystery. Types of acinetobacter bacteria occur naturally in soil and water worldwide.

However, much of the transmission of the bacteria to wounded soldiers seems to have occurred in military medical facilities. Military procedures now call for isolating and screening all incoming wounded from Iraq for acinetobacter. Strict rules of hygiene are observed to fight the bacteria, which can survive on surfaces for weeks. VA hospitals have similar requirements.

"This has the potential to become a serious problem in military and veterans hospitals, where soldiers returning from active duty worldwide are treated in the same environment as other patients," warns an article in the Journal of Clinical Microbiology.

However, the increasing drug resistance of a variety of bacteria is "not just a military problem," Wortmann says. "This is a problem that is
multinational."

Margaret Davidson is a writer who specializes in medical issues.