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Medical advances in addition to improved body armor during Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) have greatly increased the chance of survival especially among deployment related severe closed and penetrating traumatic brain injury (TBI). However, early medical complications resulting from secondary brain injury play an important role in severe TBI patient outcomes and future survival. Early-onset infectious complications that occurred at a Level IV military treatment facility (MTF) were evaluated among active duty service members that sustained a TBI while deployed during OEF and OIF from calendar years 2008 to 2013. As a group, 14.0% of severe closed and penetrating TBI patients had at least one diagnosis indicating an early-onset infectious complication, most commonly pneumonia followed by systemic infection. However, closed TBI patients developed a greater proportion of early-onset infectious complications compared to penetrating TBI patients. Of infections caused by multidrug-resistant organisms (MDROs), MDR Acinetobacter and MRSA were the predominate pathogens. MDRO infections have the potential to further complicate the care of TBI patients.

Gram-negative bacterial infections are a growing global public health and clinical concern. Additionally, epidemics of multidrug-resistant (MDR) gram-negative bacteria have occurred worldwide in the last couple decades, including regions where United States (US) military forces are regularly deployed. In 2013, the incidence of MDR Escherichia coli, Enterobacter, Klebsiella, and Pseudomonas aeruginosa in Department of Defense (DOD) beneficiaries seeking care in the Military Health System (MHS) increased from 2012. MDR E. coli was the organism most frequently identified with an incidence 37-40 times higher than the next most frequent organism. A pronounced gender disparity was noted for all organisms except MDR P. aeruginosa. Overall, DOD female beneficiaries were impacted much more than their male counterparts. Furthermore, MDR E. coli, MDR Enterobacter, and MDR Klebsiella cases commonly manifested as urinary tract infections (UTIs), which is consistent with historic observations. In 2013, cases of MDR P. aeruginosa more commonly manifested as respiratory infections, which is also consistent with historic observations. MDR P. aeruginosa did not display any consistent high susceptibilities at the population level.

Methicillin-resistant Staphylococcus aureus (MRSA) infections are a national concern for public health and hospital officials due to the opportunistic nature of the bacteria and the emergence of resistance to several antibiotics. In 2013, the MRSA incidence rates were 58.7 and 73.0 per 100,000 persons per year in the Department of Defense (DOD) and the Department of the Navy (DON) beneficiary populations, respectively; this is a 59% decrease for the DOD and DON since 2005. The majority of MRSA infections within the DOD and DON in 2013 were outpatient, community-associated (CA), and skin and soft tissue infections (SSTIs); similar patterns were observed since 2005. In the DOD from 2005-2013, MRSA isolates showed decreased susceptibility to cefazolin. However, MRSA showed increased susceptibility to erythromycin and cefotaxime in both the DOD and the DON, and to gentamicin in the DON only. The proportion of MRSA cases with inducible clindamycin resistance is increasing, with a 31.3% increase in the DOD and a 65.3% increase in the DON from 2005 to 2013. Military prescription practices in 2013 were consistent with treatments recommended by the Infectious Diseases Society of America (IDSA).

Since the early 2000s, health professionals increasingly are concerned about Acinetobacter species infections due to demonstrated ability to develop resistance to multiple antibiotics, limiting treatment options. In 2013, Acinetobacter incidence was 5.5 and 4.4 per 100,000 persons per year in the Department of the Navy (DON) and the Department of Defense (DOD), respectively, continuing previously observed descending trends. Active duty Marines had a higher prevalence rate than any other group of service members. A. baumannii was the most common etiologic agent in 2013 was, differing slightly from 2012. In the DON, a negligible increase in overall resistance was noted, though there was an increase in XDR cases. For non-MDR cases in the DON and DOD, providers often prescribed trimethoprim/sulfamethoxazole, consistent with 2012 observations. For MDR/XDR cases in 2013, DON providers most commonly prescribed colistin, minocycline, piperacillin/tazobactam, and trimethoprim/sulfamethoxazole. DOD providers most commonly prescribed ciprofloxacin for these cases. Although different from 2012, 2013 prescribing patterns were consistent with recommendations. Among DON and DOD beneficiaries respectively, organisms were most susceptible to cefepime and gentamicin while least susceptible to ampicillin and nitrofurantoin; consistent with observations for the DON and DOD from 2012.

Vancomycin-resistant Enterococci (VRE) are Gram-positive cocci that are resistant to vancomycin and most commonly infect seriously ill patients that have prolonged hospital stays or antibiotic use. Hospital acquired VRE infections are associated with high rates of morbidity and mortality and are a concern for hospitals around the world. The objective of this annual retrospective report is to summarize the VRE infection burden in the Department of Defense (DOD) and the Department of the Navy (DON) for calendar year (CY) 2013. This summary includes demographic and clinical characteristics, antibiotic susceptibility patterns, prescription practices, and HAI metrics for all DOD and DON beneficiaries. Overall, the incidence rates of VRE in the general US population, the DOD and DON are decreasing. No substantial changes in VRE risk groups were seen for 2013 as VRE continues to affect elderly females and manifest as urinary tract infections. In addition, no substantial changes in antibiotic susceptibility were seen in 2013. Linezolid, gentamicin and streptomycin remain viable treatments for VRE. Although current infection control practices seem to be decreasing the overall burden of VRE, healthcare associated infections are still a major problem for transmission of VRE in the DOD and the DON. Better infection control practices need to be introduced to help control healthcare associated infections.

Respiratory illness is a constant threat for military personnel due to crowded and stressful occupational conditions.1 Respiratory infections are among the leading causes of ambulatory visits and hospitalizations for active duty service members. It is also one of the leading causes of ambulatory clinic visits and absenteeism from work and school in the United States (US).2,3 This study used electronic clinical laboratory data to describe bacterial respiratory infections from October 2008 to September 2013, among all Department of Defense (DOD) beneficiaries seeking care within the Military Health System (MHS). Data were analyzed by fiscal year (FY), October 01 through September 30. Upper respiratory infections (URIs) displayed seasonal trends, occurring more frequently in fall and winter months. URIs occurred more frequently in the first two years of the study period (FY 2009 and FY 2010) than in the last three years of the study period. Lower respiratory infections (LRIs) declined since 2008 and lacked seasonal trends. Overall, URIs and LRIs declined by 36% and 23%, respectively, from FY 2009 to FY 2013. Additionally, there were significant changes in the demographic and clinical characteristics of URIs and LRIs. Beneficiaries 5-17 years of age were consistently most impacted by URIs, whereas those 45 years of age and older had the highest rates of LRIs. Periodic monitoring contributes to risk reduction by tracking trends and identifying populations that exceed baseline, which may help to mitigate increased risk of morbidity and mortality, given the occupational realities of DOD personnel.

The EpiData Center Department (EDC) at the Navy and Marine Corps Public Health Center (NMCPHC) conducts routine surveillance of clinically significant organisms within the Department of the Navy (DON) as well as the Department of Defense (DOD). This report provides a summary of Acinetobacter species isolates in calendar year (CY) 2012 and describes the demographics, clinical characteristics, prescription practices, and antibiotic resistance patterns observed among all DOD beneficiaries as well as active duty DON service members and recruits. Acinetobacter species are associated with a large number of infections, have the ability to easily acquire resistance determinants, and quickly develop resistance to multiple antibiotics, leaving few, if any, treatment options. In calendar year (CY) 2012, the overall Acinetobacter infection rate was 5.3 per 100,000 beneficiaries in the Department of the Navy (DON) and 4.8 per 100,000 beneficiaries in the Department of Defense (DOD); both rates decreased from previous years. Acinetobacter among DON beneficiaries was most frequently identified in the outpatient setting (76.7%), from non-sterile body sites (61.3%), and among 18-24 year olds (36.0%). The most common species identified was A. baumannii (42.7%). For MDR/XDR cases, providers most commonly prescribed vancomycin, meropenem, or doxycycline. Cases with susceptibility testing results showed that, among DON beneficiaries, organisms were most susceptible to gentamicin (92.4%), followed by imipenem (91.2%), and levofloxacin (90.0%); organisms were least susceptible to ampicillin (7.0%). This report could help infection preventionists and infectious disease practitioners make informed decisions on the treatment of Acinetobacter infections. In addition, this report monitors antibiotic resistance in this organism. Understanding the current disease dynamics will help ensure military health providers have the best information possible, thus ensuring quality care and missi

The EpiData Center Department (EDC) at the Navy and Marine Corps Public Health Center (NMCPHC) evaluated the Health Level 7 (HL7) data source for its usefulness in health surveillance activities. This technical document provides a history of the HL7 microbiology database and its contents, explains the creation of microbiology records, describes the pathway of data from healthcare provider to the EDC, provides a detailed descriptions of all variables within the database, and assesses the database's strengths and limitations. Given an understanding of the strengths and limitations of the data, HL7 microbiology data have proven to be a valuable source of health information for surveillance purposes. The data allow the creation of a timeline of events corresponding to a specific disease occurrence. Furthermore, data are received in a timely fashion, allowing for near-real-time surveillance of diseases.