Multidrug-resistant chronic osteomyelitis complicating war injury in Iraqi civilians

Murphy, Richard A., Ronat, Jean-Baptiste, Fakhri, Rasheed M., Herard, Patrick, Blackwell, Nikki, Abgrall, Sophie and Anderson, Deverick J. (2011) Multidrug-resistant chronic osteomyelitis complicating war injury in Iraqi civilians. Journal of Trauma-Injury Infection and Critical Care, 71 1: 252-254. doi:10.1097/TA.0b013e31821b8622

Author Murphy, Richard A.
Ronat, Jean-Baptiste
Fakhri, Rasheed M.
Herard, Patrick
Blackwell, Nikki
Abgrall, Sophie
Anderson, Deverick J.
Title Multidrug-resistant chronic osteomyelitis complicating war injury in Iraqi civilians
Journal name Journal of Trauma-Injury Infection and Critical Care   Check publisher's open access policy
ISSN 0022-5282
Publication date 2011-07
Sub-type Article (original research)
DOI 10.1097/TA.0b013e31821b8622
Volume 71
Issue 1
Start page 252
End page 254
Total pages 3
Place of publication Baltimore, MD, United States
Publisher Lippincott Williams & Wilkins
Collection year 2012
Language eng
Formatted abstract
Background: War-related orthopedic injury is frequently complicated by environmental contamination and delays in management, placing victims at increased risk for long-term infectious complications. We describe, among Iraqi civilians with war-related chronic osteomyelitis, the bacteriology of infection at the time of admission.

Methods: In the Médecins Sans Frontières Reconstructive Surgery Project in Amman, Jordan, we retrospectively reviewed baseline demographics and results of initial intraoperative surgical cultures among Iraqi civilians with suspected osteomyelitis.

Results: One hundred thirty-seven patients (90% male; median age, 35 years [interquartile range {IQR}, 28–46]; median time since initial injury, 19 months [IQR, 10–35]) were admitted with suspected chronic osteomyelitis after war-related injury. One hundred seven patients had a positive intraoperative culture. Before arrival, patients had undergone a median of 4 (IQR, 2–6) surgical procedures in Iraq. Fifty-nine (55%) of 107 patients with confirmed osteomyelitis had a multidrug-resistant (MDR) organism isolated at admission: cefepime-resistant Enterobacteriaceae (n = 40), methicillin-resistant Staphylococcus aureus (n = 16), and MDR Acinetobacter baumannii (n = 3). An association of borderline significance existed between a history of more than two prior surgical procedures in Iraq and an MDR isolate at program entry (multivariate: odds ratio, 5.3; 95% confidence interval, 0.9–30.6; p = 0.064).

Conclusion: Health care actors, including Iraqi health facilities and humanitarian medical organizations, must be aware of the link between chronic war injury and antimicrobial drug resistance in this region and should be prepared for the management challenges involved with the treatment of chronic drug-resistant osteomyelitis.
Keyword Drug resistance
War surgery
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Official 2012 Collection
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