Abstract
The spread of multidrug-resistant bacteria in resource-poor settings affects the military medical service in case of deployments of soldiers to war and crisis zones. Patients with war injuries are prone to colonization or infection with multidrug-resistant bacteria. Resistant Gram-negative bacteria play a dominant role in military wound infections. Problematic hygiene conditions on deployment facilitate exposition of soldiers with subsequent colonization. Although colonizing strains are frequently cleared from their hosts after returning from deployment, transmission to close contacts of the soldiers in the home country cannot be excluded and therapeutic options are reduced if colonization progresses to invasive infection. Since sophisticated culture-based diagnostic approaches are typically not available in the field setting on deployment, molecular rapid diagnostic test systems are an option for transmission control if the locally prevalent molecular resistance mechanisms are known. Efforts for global resistance surveillance can contribute to better understanding of resistance distribution and spread at deployment sites. This review summarizes experience of the military medical services with multidrug resistance on deployment and with the influx of resistant strains to the home country and discusses potential use of available molecular rapid test systems as an option for the field setting.
Highlights
Traveling to resource-limited areas is associated with reversible but substantial changes of the human gut microbiome [1]
Such studies provide a first overview on performance characteristics of molecular rapid diagnostic test (RDT) systems and are summarized in the following
In a serial dilution of stool samples spiked with a blaNDM-positive K. pneumoniae strain, 100% positivity at dilutions from 300 to 1,800 colony forming units / ml and 93.3% at 150 cfu / ml were observed [58]
Summary
Traveling to resource-limited areas is associated with reversible but substantial changes of the human gut microbiome [1]. As preanalytic conditions like swabbing techniques [11] and the use of enrichment broths [12] were shown to relevantly affect the reliability of enteric screening approaches, it is highly likely that a proportion of individuals with apparently cleared colonization remains colonized with multidrug-resistant bacteria on a level below the diagnostic threshold. For these persons, there is a risk of selective. In this narrative review, published experience of military medical services with Gram-negative multidrug-resistant bacteria is summarized and mobile, field compatible diagnostic systems are introduced
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