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The War — and the War on Disease

By ZACH PATTON

As the spread of drug-resistant "superbugs" becomes an increasingly pressing public health concern, epidemiologists say they're worried about a new factor that could make the problem even worse: the war in Iraq.

Wounded soldiers returning from tours of duty in Iraq and Afghanistan are importing stronger strains of certain bacteria — pathogens that can survive treatments that traditionally have been effective at eradicating them. Some health officials are calling it the next drug-resistant infection epidemic.

"Soldiers with infected injuries are bringing new bacteria into the American health care system," says Dr. David Gilbert, a past president of the Infectious Disease Society of America and a member of the group's "Bad Bugs, No Drugs" task force. "It's getting to be a major concern."

Specifically, these soldiers have been infected with bacteria known as Acinetobacter baumannii. The pathogen can cause several kinds of infections, including in the bloodstream, the respiratory tract, the urinary tract, on the skin and in open wounds. Acinetobacter has historically been limited to hospital ICU's and among patients with already-weakened immune systems.

But soldiers infected in the field have been exhibiting a more virulent strain of Acinetobacter, one that does not respond to treatment. Since Operation Iraqi Freedom began in March 2003, more than 700 US soldiers have been infected or colonized with Acinetobacter, according to a February article from Wired.

Epidemiologists say the current uptick in Acinetobacter mirrors the situation in the 1970s, when veterans of the Vietnam conflict brought home drug-resistant strands of gonorrhea. Since then, battlefield logistics have improved dramatically. Soldiers wounded in Vietnam were six weeks away from seeing a U.S. hospital, and one in four of them died en route. Today, soldiers hurt in Iraq have a nine-in-10 chance of surviving battle injuries. More lives are spared, but there are now many more opportunities for infections to take hold.

Mortality rates for drug-resistant Acinetobacter now stand at 20 to 50 percent — almost four times deadlier than that of the weaker strains of the disease. Unable to treat Acinetobacter with the usual drugs, doctors have been forced to revert to an old drug called colistin, which had previously been abandoned because it was considered too toxic. Colistin can cause kidney damage in as many as one in four patients who take it.

In the meantime, the Infectious Disease Society has added Acinetobacter to its "hit list" of bad bugs. The group is pushing for Congress to provide incentives to drug companies to get them to develop new antibiotics. "The big drug companies have all just withdrawn," says Gilbert. "They've dismantled their R&D efforts for antimicrobials."

Infections in soldiers coming home from Iraq are worsening the spread, Gilbert says, and before long there may be no drug at all to treat this disease.

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