Background
Methods
Participants
Surveillance cultures
Troop medical clinic, San Antonio, TX
Acute care clinic in Afghanistan
Antimicrobial susceptibility testing
Molecular testing
Statistical analysis
Results
Demographics of study participants
Gram negative bacteria from US-based subjects
Isolate** | Nares | Oropharynx | Axilla | Groin | Hand | Foot | Perirectal | Number of participants colonized |
---|---|---|---|---|---|---|---|---|
Total MDR bacteria (all Escherichia coli) | 0 | 0 | 0 | 0 | 0 | 0 | 2 (3) | 2 (3) |
Total non-MDR bacteria | 4 (4) | 14 (17) | 11 (12) | 9 (14) | 7 (7) | 27 (35) | 65 (99) | 85 (188) |
Acinetobacter baumannii-calcoaceticus complex | 0 | 1 (1) | 0 | 0 | 1 (1) | 4 (4) | 2 (2) | 8 (8) |
Acinetobacter lwoffii
| 0 | 1 (1) | 0 | 1 (1) | 0 | 4 (5) | 2 (2) | 8 (9) |
Alcaligenes species | 0 | 1 (1) | 0 | 0 | 1 (1) | 2 (2) | 1 (1) | 5 (5) |
Citrobacter species | 0 | 0 | 0 | 0 | 0 | 0 | 11 (11) | 11 (11) |
Enterobacter aerogenes
| 1 (1) | 0 | 2 (2) | 1 (1) | 0 | 0 | 1 (1) | 5 (5) |
Enterobacter cloacae
| 0 | 1 (1) | 0 | 0 | 1 (1) | 0 | 4 (4) | 6 (6) |
Escherichia coli
| 2 (2) | 0 | 2 (3) | 1 (1) | 0 | 0 | 49 (54) | 49 (60) |
Klebsiella oxytoca
| 0 | 1 (1) | 0 | 1 (1) | 0 | 0 | 2 (3) | 2 (5) |
Klebsiella pneumoniae
| 0 | 1 (1) | 1 (1) | 2 (2) | 0 | 1 (1) | 8 (8) | 12 (13) |
Proteus species | 0 | 0 | 1 (1) | 0 | 0 | 1 (1) | 0 | 2 (2) |
Pseudomonas aeruginosa
| 0 | 4 (4) | 0 | 0 | 0 | 2 (2) | 0 | 5 (6) |
Serratia marcescens
| 1 (1) | 1 (1) | 4 (4) | 1 (1) | 2 (2) | 2 (2) | 1 (1) | 9 (12) |
Stenotrophomonas maltophilia
| 0 | 2 (2) | 0 | 0 | 0 | 3 (3) | 1 (1) | 5 (6) |
Other*** | 0 | 4 (4) | 1 (1) | 4 (7) | 2 (2) | 12 (15) | 11 (11) | 34 (40) |
US (n=101) | Afghanistan (n=100) | P value | |
---|---|---|---|
Age (median, IQR) | 22 (20,25) | 23 (22,25.8) | 0.07 |
Gender- males | 69 | 100 | <0.01 |
Total colonized | 85 | 84 | 0.98 |
Nares | 4 | 12 | 0.04 |
Oropharynx | 14 | 8 | 0.26 |
Axilla | 11 | 13 | 0.65 |
Groin | 9 | 23 | <0.01 |
Hand | 7 | 12 | 0.22 |
Foot | 27 | 13 | 0.15 |
Perirectal | 66 | 70 | 0.48 |
Total multidrug resistant (MDR) colonized | 2 | 11 | 0.01 |
Groin | 0 | 4 | 0.12 |
Foot | 0 | 1 | 0.50 |
Perirectal | 2 | 9 | 0.03 |
All bacteria | |||
Acinetobacter baumannii-calcoaceticus complex | 8 | 4 | 0.24 |
Acinetobacter lwoffii
| 8 | 13 | 0.24 |
Citrobacter species | 11 | 5 | 0.19 |
Enterobacter aerogenes
| 5 | 9 | 0.28 |
Enterobacter cloacae
| 6 | 3 | 0.50 |
Escherichia coli
| 51 | 67 | 0.02 |
Klebsiella pneumoniae
| 12 | 20 | 0.12 |
Pseudomonas aeruginosa
| 5 | 2 | 0.45 |
Serratia marcescens
| 9 | 1 | 0.02 |
Stenotrophomonas maltophilia
| 5 | 0 | 0.06 |
Total sites colonized | 0.44 | ||
0 | 16 | 16 | |
1 | 48 | 36 | |
2 | 24 | 31 | |
3 | 10 | 15 | |
4 | 3 | 2 | |
Total gram-negative rod bacteria isolates | 0.62 | ||
0 | 16 | 16 | |
1 | 32 | 24 | |
2 | 23 | 22 | |
3 | 17 | 21 | |
4 | 7 | 10 | |
5 | 4 | 5 | |
6 | 0 | 1 | |
7 | 2 | 0 | |
10 | 0 | 1 |
Participant | Country of study | Resistance profile | Antimicrobial Resistance Testing | ||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Amikacin | Ampicillin- Sulbactam | Aztreonam | Cefepime | Cefoxitin | Ceftazidime | Ceftriaxone | Cefuroxime | Ciprofloxacin | Ertapenem | Gentamicin | Imipenem | Levofloxacin | Meropenem | Moxifloxacin | Nitrofurantoin | Piperacillin- Tazobactam | Tobramycin | Trimethoprim- Sulfamethoxazole | |||
6 | US | MDR | S | R | R | S | R | R | R | R | R | S | R | S | R | S | R | S | R | I | R |
6 | US | MDR | S | R | R | S | R | R | R | R | R | S | R | S | R | S | R | S | R | I | R |
9 | US | ESBL | S | R | R | R | I | R | R | R | R | S | S | S | R | S | R | S | S | S | R |
% susceptible by unique isolate per unique participant | 100 | 0 | 0 | 50 | 0 | 0 | 0 | 0 | 0 | 100 | 50 | 100 | 0 | 100 | 0 | 100 | 50 | 50 | 0 | ||
1 | Afghan | MDR | S | R | R | S | R | R | R | R | S | S | S | S | S | S | S | S | I | S | R |
1 | Afghan | MDR | S | R | R | S | R | R | R | R | S | S | S | S | S | S | S | S | I | S | R |
2 | Afghan | ESBL | S | R | R | R | I | R | R | R | R | S | R | S | R | S | R | S | S | R | R |
3 | Afghan | ESBL | S | R | R | R | S | R | R | R | S | S | S | S | S | S | S | S | S | S | R |
3 | Afghan | ESBL | S | R | R | R | S | R | R | R | S | S | S | S | S | S | S | S | I | S | R |
4 | Afghan | ESBL | S | R | R | R | I | R | R | R | S | S | S | S | S | S | S | S | S | S | S |
5 (PFT 5) | Afghan | ESBL | S | R | R | R | S | R | R | R | S | S | S | S | S | S | S | S | S | S | R |
5 (PFT 8) | Afghan | ESBL | S | R | R | R | S | R | R | R | R | S | S | S | R | S | R | S | S | R | R |
7 | Afghan | ESBL | S | R | R | R | S | R | R | R | R | S | S | S | R | S | R | I | S | S | R |
8 | Afghan | ESBL | S | R | R | R | S | R | R | R | R | S | S | S | R | S | R | S | S | R | R |
10 | Afghan | ESBL | S | R | R | R | S | R | R | R | S | S | S | S | S | S | S | I | S | S | R |
11 | Afghan | ESBL | S | R | R | R | S | R | R | R | R | S | S | S | R | S | R | S | S | S | R |
12 | Afghan | ESBL | S | R | R | R | S | R | R | R | S | S | S | S | S | S | I | S | S | S | R |
12 | Afghan | ESBL | S | R | R | R | S | R | R | R | S | S | S | S | S | S | I | S | S | S | R |
13 | Afghan | ESBL | S | R | R | R | S | R | R | R | R | S | S | S | R | S | R | S | S | R | R |
% susceptible by unique isolate per unique participant | 100 | 0 | 0 | 8 | 75 | 0 | 0 | 0 | 42 | 100 | 92 | 100 | 50 | 100 | 42 | 83 | 92 | 75 | 8 |
Participant |
tet(A) |
tet(B) | Doxycycline | Minocycline | Tetracycline |
---|---|---|---|---|---|
1 | + | - | R | S | R |
1 | + | - | R | S | R |
2 | - | + | R | R | R |
3 | + | - | I | S | R |
3 | + | - | I | S | R |
4 | - | - | S | S | S |
5 (PFT 5) | - | + | R | I | R |
5 (PFT 8) | + | - | R | I | R |
6 | + | - | R | I | R |
6 | + | - | R | I | R |
7 | - | + | R | R | R |
8 | + | - | R | I | R |
9 | - | + | R | R | R |
10 | - | + | R | R | R |
11 | - | + | R | R | R |
12 | + | - | R | I | R |
12 | + | - | R | I | R |
13 | + | - | R | I | R |
Gram negative bacteria from Afghanistan-based subjects
Isolate* | Nares | Oropharynx | Axilla | Groin | Hand | Foot | Perirectal | Number of participants colonized |
---|---|---|---|---|---|---|---|---|
Total MDR bacteria (all Escherichia coli) | 0 | 0 | 0 | 4 (4) | 0 | 1 (1) | 9 (10) | 11 (15) |
Total non-MDR bacteria | 12 (13) | 8 (10) | 13 (14) | 20 (27) | 12 (12) | 12 (14) | 65 (107) | 80 (197) |
Acinetobacter baumannii-calcoaceticus complex | 0 | 0 | 0 | 0 | 1 (1) | 3 (3) | 0 | 4 (4) |
Acinetobacter lwoffii
| 0 | 0 | 3 (3) | 2 (2) | 5 (5) | 5 (5) | 1 (1) | 13 (16) |
Alcaligenes species | 0 | 1 (1) | 0 | 2 (2) | 1 (1) | 2 (2) | 1 (1) | 5 (7) |
Citrobacter species | 1 (1) | 0 | 0 | 0 | 0 | 1 (1) | 3 (3) | 5 (5) |
Enterobacter aerogenes
| 5 (6) | 2 (2) | 4 (4) | 1 (1) | 1 (1) | 0 | 2 (2) | 9 (16) |
Enterobacter cloacae
| 0 | 1 (2) | 0 | 1 (1) | 0 | 1 (1) | 0 | 3 (4) |
Escherichia coli
| 2 (2) | 0 | 3 (3) | 12 (17) | 0 | 0 | 57 (75) | 59 (97) |
Klebsiella oxytoca
| 3 (3) | 0 | 0 | 0 | 0 | 0 | 0 | 3 (3) |
Klebsiella pneumoniae
| 0 | 0 | 2 (2) | 2 (2) | 0 | 0 | 19 (20) | 20 (24) |
Proteus species | 0 | 0 | 1 (1) | 0 | 0 | 0 | 2 (2) | 3 (3) |
Pseudomonas aeruginosa
| 0 | 1 (1) | 0 | 1 (1) | 0 | 0 | 2 (2) | 2 (4) |
Serratia marcescens
| 1 (1) | 1 (2) | 0 | 0 | 0 | 0 | 0 | 1 (3) |
Stenotrophomonas maltophilia
| 0 | 0 | 0 | 0 | 0 | 0 | 0 | 0 |
Other** | 0 | 2 (2) | 1 (1) | 1 (1) | 4 (4) | 2 (2) | 1 (1) | 11 (11) |