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Genesis of Clinical Microbiology in the CSH - Afghanistan 2002 LTC John M. Scherer Ph.D., M.T. ( ASCP )

Genesis of Clinical Microbiology in the CSH - Afghanistan 2002 LTC John M. Scherer Ph.D., M.T. ( ASCP ). HISTORY. May 2002 Outbreak of unknown illness among British soldiers Unknown etiology Critically ill Spreading person-to-person 44 th MEDCOM responsible for HCO

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Genesis of Clinical Microbiology in the CSH - Afghanistan 2002 LTC John M. Scherer Ph.D., M.T. ( ASCP )

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  1. Genesis of Clinical Microbiology in the CSH - Afghanistan 2002 LTC John M. Scherer Ph.D., M.T. (ASCP)

  2. HISTORY • May 2002 • Outbreak of unknown illness among British soldiers • Unknown etiology • Critically ill • Spreading person-to-person • 44th MEDCOM responsible for HCO • Currently no CSH in Afghanistan • Concern over inability to ID any infectious diseases • 520th TAML had the capability but not all the components • Three-person team deployed July 2002 met up with 339th CSH in August

  3. MISSION To deploy the developmental M403 Microbiology Augmentation Set to Bagram Air Force Base in Afghanistan, work out supply issues, train the 339th CSH in its use, and redeploy back to COUNS for future deployment to Kuwait.

  4. CAPABILITIES • Culture: Wounds, Blood, Stools, Urine, Respiratory, Fluids, etc. • Antibiotic Susceptibilities: GNR & GPC (- Strep pneumo) • RAPID tests: Group A Strep, Influenza, Strep pneumo, some Protozoa • O&P • Direct Fungal Staining • Malaria Staining

  5. ITEMS NOT PART OF THE KIT • Mycobacterium staining or culture • Anaerobe identification • Fungal identification

  6. America's Deployable Medical Command

  7. America's Deployable Medical Command

  8. America's Deployable Medical Command

  9. Isolates and Susceptibility Patterns

  10. America's Deployable Medical Command Coagulase test

  11. America's Deployable Medical Command

  12. Demographics of Microbiology Workload 452nd Combat Support Hospital, Bagram Afghanistan (April 1, 2003 to Mar 15, 2004)

  13. Most commonly isolated organisms from 452nd Combat Support Hospital, Bagram Afghanistan (April 1, 2003 to Mar 15, 2004). *These 12 organisms account for approximately 85% of the total number of positive cultures.

  14. Most common isolated organisms based on culture type 452nd Combat Support Hospital, Bagram Afghanistan (April 1, 2003 to Mar 15, 2004).

  15. ESBL activity as measured by Ceftazidime resistance Annals of Clinical Microbiology and Antimicrobials 2004; 3:7 Journal of Antimicrobial Chemotherapy 2000; 45: 295-303

  16. E. Coli Susceptibility Pattern Annals of Clinical Microbiology and Antimicrobials 2004; 3:7 Antimicrobial Agents and Chemotherapy 2001; 1402–1406

  17. CLINICAL CONCLUSIONS • Overall, the set performed exceptionally well • Susceptibility patterns are different than those observed in the US • Some tests will not provide the same performance as they do in the US • Gram negative rods were frequently isolated from blast wounds (not Acinetobacter)

  18. IMPACT BEYOND PATIENT CARE • Maintain soldiers with local knowledge in theater • Decreases casualty movement/decreased logistical burden • Mission readiness • - Bacterial versus viral meningitis

  19. America's Deployable Medical Command Questions Special Thanks to CPT Scott Cvecko for the data from the 452nd CSH

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