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The Honolulu Advertiser

Posted on: Wednesday, July 14, 2004

Drug-resistant 'superbug' traced to war in Iraq

By William Cole
Advertiser Military Writer

After a helicopter crash in Iraq, Chief Warrant Officer 3 Claude Boushey Sr. underwent surgery in Germany for a broken back and to insert a titanium rod into his left leg.

Moved later to Tripler Army Medical Center, the Schofield Barracks pilot found out something else: He had tested positive for antibiotic-resistant bacteria known as Acinetobacter baumanii.

"I was kind of alarmed. I was like, what is it?" said Boushey, a 1983 Campbell High School graduate. "It took me a week just to pronounce it."

The so-called superbug, a peculiarity of the Iraq war, can cause infections, fever and pneumonia.

A spate of about 50 cases involving soldiers evacuated from Iraq was noticed in 2003 aboard the Navy hospital ship Comfort. Two Iraqi patients died of the infection.

None of the cases involved fighting in Afghanistan. The numbers are noteworthy, said the International Society for Infectious Diseases, since the infection was not noted in the 1991 Gulf War.

Seven cases of acinetobacter have been recorded at Tripler for Iraq war veterans, the first around April. A total of 136 Pacific-based soldiers serving in Iraq and Afghanistan have come through Tripler for outpatient or inpatient care.

One acinetobacter patient was identified as having the bacteria before arriving at Tripler. The six positives identified at the hospital included four actual infections and two who had it on their skin, but weren't infected, said Col. Susan Fraser, chief of infectious diseases at Tripler.

"They (the cases) have come out of Iraq, and the other oddity is it's very, very drug-resistant, and that's unusual," Fraser said. The bacteria have been successfully treated with the Carbapenem class of antibiotics. Amikacin and Polymixin B also can be used, she said.

Fraser said the bacteria, believed to live in soil, are found around the world.

"It's actually the type of bacteria that we see in hospitals — oftentimes in intensive-care units," Fraser said. "This particular bacteria takes advantage of people who are sick, people who are on ventilators for instance, so they've got artificial breathing tubes, and they've got IVs stuck in all different kind of veins."

What's different at Tripler, at least in the past three years that Fraser has been there, is the drug resistance.

"That's the first time at least that I've seen (the multiple-drug resistant variety)," she said.

Acinetobacter can reside harmlessly on the skin. Fraser said that if cultures were taken from 100 people pulled off Waikiki Beach, some of them would turn up positive. "It's not something that the general public needs to be afraid of or scared of," she said.

Why Iraq has been tied to positive tests for acinetobacter infections and not Afghanistan is a mystery.

"None of us really know the answer to that question," she said.

Fraser said the information she received was that 15 percent of the soldiers being screened at Walter Reed Army Medical Center in Washington tested positive for the bacteria.

All soldiers returning from the battlefield for care at Tripler now are screened for the bacteria.

Boushey, 38, and his co-pilot, Lt. Dwight Mears, 25, crash-landed in their OH-58D on June 13 near Taji Air Base north of Baghdad.

Mears said the observation helicopter experienced an engine failure as the pair were traveling low and fast, and Boushey, the more experienced pilot, guided the chopper to a swampy area.

"I credit him with steering us away from several lethal obstacles, such as a house and telephone wires that we nearly impacted," Mears said.

Mears, who also broke his back, is recovering in his hometown of Corvallis, Ore. His father said he has not tested positive for acinetobacter.

Reach William Cole at wcole@honoluluadvertiser.com or 525-5459.