Experts fear an infection caught by troops in Iraq and Afghanistan will invade civilian hospitals



Peter Beaumont, foreign affairs editor
Sunday December 16, 2007

The UK, the United States and Canada are facing growing fears over a drug-resistant ‘superbug’ being brought back by wounded soldiers from Afghanistan and Iraq that threatens to contaminate civilian hospitals.

The intensified concern comes amid sharply rising infection rates in the US and fresh worries in Canada that the bug could be imported into its civilian healthcare system. Military health officials who have studied the bacterium in Afghanistan believe the infection of wounded British soldiers in field hospitals there is probably inevitable.

The US military originally thought the bug came from contaminated Iraqi soil, but troops in Afghanistan have also been infected. Canada’s public health service last week revealed it had ordered the screening of all its wounded soldiers being repatriated from Afghanistan.

The bacterium, Acinetobacter baumannii, first emerged as a ‘mystery infection’ afflicting US service personnel returning from the war in Iraq in 2003-04. It was described by a scientific journal specialising in hospital epidemiology as the ‘most important emerging hospital-acquired pathogen worldwide’. The journal added that it was potentially a ‘major threat to public health’ due to its ability to mutate rapidly and develop a resistance to all known drugs.

Although different types of acinetobacter have been known for decades in hospitals, the new ‘T’ strain identified in the injured troops is particularly virulent and has been observed to appear in US servicemen within two hours of being admitted to a field hospital. It affects the spinal fluid, bones and lungs, causing pneumonia, respiratory failure and other complications. Equally worrying is its resilience. Extremely difficult to eliminate from medical facilities once established, the bug can survive for up to 176 days in a human host. US officials concede that, once established in the medical evacuation chain, the germ is almost impossible to stamp out.

Although the Ministry of Defence tried to play down fears of the infection when the first suspected British cases were reported last year in the Lancet, its increasingly rampant progress through America’s military hospital system has been causing intense alarm elsewhere.

Canadian military doctors investigated the infection in Canadian troops at an intensive care unit in Kandahar and published a report in the journal BMC Infectious Diseases earlier this year.

The officers warned that their findings about the infection risk were ‘equally applicable to US and British military field hospitals as well’, adding that ‘the environmental and logistical problems that faced [the medical units involved] are common across field hospitals in Afghanistan and Iraq’. They added that ‘unrestricted use of antibiotics’ at the field hospitals to compensate for poor environmental conditions had contributed to the emergence of the new superstrain.

In addition to a new screening regime, Canadian infectious disease officials will meet early next year to develop a national strategy to deal with the risk of the new strain spreading to civilian hospitals.

One of the report’s authors, Major Homer Tien, told The Observer from Kandahar yesterday that further outbreaks appeared inevitable. ‘No one really knows how it is being transmitted. What is certain is that it is a big concern,’ he said. ‘A lot of the work I was doing was trying to pinpoint the source of the infection. We still can’t say what the source was. If we can’t prevent it, the next question is how we can keep the hospitals back home in the UK and Canada from being infected.’

Concern is all the higher because, as in the UK, injured Canadian troops are treated in the civilian healthcare system, while most Americans are treated in an extensive network of military hospitals.

Infection rates have risen steeply in the US. In 2001 and 2002, around 2 per cent of admissions were infected at a specialist army burns unit in Texas. By 2003 the rate had risen to 6 per cent, then 12 per cent by 2005, a rate consistent with other facilities. So far, 27 servicemen have died from the infection.

In stark contrast to Canada and the US, the attitude towards the threat in the UK has been sanguine and low-key.

An MoD spokesmen last week insisted there had not been a case since November 2004 and it employed ‘robust and stringent infection control procedures which fully meet NHS requirements adequate to deal with the problem’.

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06.04.2007: Call to screen all prospective hospital patients for superbug
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