The American Journal of Tropical Medicine and Hygiene, 2006
We conducted a phase 1 trial of candidate malaria vaccine RTS,S/AS02A in western Kenya to determi... more We conducted a phase 1 trial of candidate malaria vaccine RTS,S/AS02A in western Kenya to determine its safety and immunogenicity in healthy adults in an area hyperendemic for malaria. Twenty adults were enrolled and received RTS,S/AS02A (50 g of RTS,S in 0.5 mL of AS02A) by intramuscular injection on a 0-, 28-, and 178-day schedule. All 60 scheduled immunizations were given, and 18 of 20 volunteers completed the last study visit on day 210. The vaccine was safe and well-tolerated. There were no vaccine-related severe adverse events. The most common solicited adverse events associated with immunization were injection site pain and headache. The geometric mean concentration of antibodies to circumsporozoite protein was 1.9 g/mL at baseline and it increased 2-4 weeks after each dose to 16, 17.8, and 36.6 g/mL, respectively. These safety and immunogenicity data from adults in hyperendemic Kenya are comparable to data reported earlier from two trials in west African adults in hypo-endemic and meso-endemic areas of The Gambia. We conclude that in this small study, RTS,S/AS02A is safe and similarly immunogenic in malaria-exposed African adults of different ethnicity in different transmission settings.
Background Bordetella pertussis is one of the leading causes of vaccine preventable death and mor... more Background Bordetella pertussis is one of the leading causes of vaccine preventable death and morbidity globally. Over the last 20 years, pertussis has resurged worldwide, even in territories with high immunization coverage. To improve vaccine strategies, a greater understanding of human B. pertussis infection and immunity is required. This study aims to develop a safe controlled human B. pertussis infection model and to define natural immune responses against wild-type B. pertussis in order to facilitate the development of bioassays and next-generation pertussis vaccines. Methods In this first-in-human controlled infection model, healthy volunteers aged 18–45 years with an anti-pertussis toxin (PT) IgG level of <20 IU/mL were inoculated intranasally with B. pertussis strain B1917. Safety, colonization, and shedding were monitored over a 17-day inpatient period. Colonization was assessed by culture and qPCR of nasal washes and nasopharyngeal swabs. Azithromycin eradication therap...
We summarise an ethically approved protocol for the development of an experimental human challeng... more We summarise an ethically approved protocol for the development of an experimental human challenge colonisation model. Globally Bordetella pertussis is one of the leading causes of vaccine-preventable death. Many countries have replaced whole cell vaccines with acellular vaccines over the last 20 years during which pertussis appears to be resurgent in a number of countries in the developed world that boast high immunisation coverage. The acellular vaccine provides relatively short-lived immunity and, in contrast to whole cell vaccines, may be less effective against colonisation and subsequent transmission. To improve vaccine strategies, a greater understanding of human B. pertussis colonisation is required. This article summarises a protocol and does not contain any results. A controlled human colonisation model will be developed over two phases. In phase A, a low dose of the inoculum will be given intranasally to healthy participants. This dose will be escalated or de-escalated unt...
The RTS,S candidate malaria vaccine can protect against controlled human malaria infection (CHMI)... more The RTS,S candidate malaria vaccine can protect against controlled human malaria infection (CHMI), but how protection is achieved remains unclear. Here, we have analyzed longitudinal peripheral blood transcriptome and immunogenicity data from a clinical efficacy trial in which healthy adults received three RTS,S doses 4 weeks apart followed by CHMI 2 weeks later. Multiway partial least squares discriminant analysis (N-PLS-DA) of transcriptome data identified 110 genes that could be used in predictive models of protection. Among the 110 genes, 42 had known immune-related functions, including 29 that were related to the NF-κB-signaling pathway and 14 to the IFN-γ-signaling pathway. Post-dose 3 serum IFN-γ concentrations were also correlated with protection; and N-PLS-DA of IFN-γ-signaling pathway transcriptome data selected almost all (44/45) of the representative genes for predictive models of protection. Hence, the identification of the NF-κB and IFN-γ pathways provides further insi...
ABSTRACT Background: Collection of multidrug-resistant organisms (MDRO) and aggregation of associ... more ABSTRACT Background: Collection of multidrug-resistant organisms (MDRO) and aggregation of associated information are essential to understanding the challenges, successes and failures the Army’s healthcare system faces in controlling the current epidemic of infections with these bacteria. Objective: Begin collection of these pathogens along the entire evacuation chain to enable spatial analysis and epidemiologic profiling necessary to determine attributable origins, patterns of spread, and mechanisms of resistance. Methods: In June 2009, the Army Medical Command authorized the Walter Reed Army Institute of Research to establish the MRSN, consisting of a microbiology laboratory, repository and an Army-wide surveillance network. Army hospitals submit all MDRO encountered during healthcare delivery and active surveillance to the network repository, along with the associated clinical-demographic information. The repository determines their genetic relatedness, performs extended phenotypic and phylogenetic analyses, and preserves them indefinitely. Analogous to successful civilian programs, monitoring and feedback of infection control components along with site visits comprise key tenets of the MRSN. Results: Site assistance visits to stateside and overseas facilities were conducted. By October 2009, over 800 MDRO from three major military referral centers were collected, centralized and are currently undergoing clonal analysis. The MRSN also assisted in one outbreak investigation. The first of the monthly reports to healthcare policy makers and infection preventionists will be issued in December 2009. Ultimately, facility specific, regional and global antibiograms along with other epidemiologic data will be made available on a secure web-enabled database. Archived isolates will be available to investigators. Conclusions: System-wide active surveillance, standardized characterization and centralized archiving of these organisms may enhance infection prevention and control efforts and earlier detection of outbreaks. Opportunities for future collaboration with HHS and the VA will be discussed.
The Transformation of Academic Health Centers, 2015
The past 12 years of armed conflict in Iraq and Afghanistan have required the Department of Defen... more The past 12 years of armed conflict in Iraq and Afghanistan have required the Department of Defense’s Military Health System to consider new ways to assess and implement approaches to combat injuries for which older methods proved to be inadequate. We provide several examples that, while not subjected to traditional randomized control trials, have been rigorously evaluated and implemented. This focused empiricism has resulted in the lowest died-of-wounds rate in the history of warfare. Many of these developments have already been incorporated into civilian practice. Moreover, the focused, empirical approach may offer an alternative means of carefully evaluating novel modalities where randomized controlled trials are impractical.
Colorectal cancer (CRC) is a major burden to healthcare systems worldwide accounting for approxim... more Colorectal cancer (CRC) is a major burden to healthcare systems worldwide accounting for approximately one million of new cancer cases worldwide. Even though, CRC mortality has decreased over the last 20 years, it remains the third most common cause of cancer-related mortality, accounting for approximately 600,000 deaths in 2008 worldwide. A multitude of risk factors have been linked to CRC, including hereditary factors, environmental factors and inflammatory syndromes affecting the gastrointestinal tract. Recently, various pathogens were added to the growing list of risk factors for a number of common epithelial cancers, but despite the multitude of correlative studies, only suggestions remain about the possible relationship between selected viruses and bacteria of interest and the CRC risk. United States military service members are exposed to various risk factors impacting the incidence of cancer development. These exposures are often different from that of many sectors of the civilian population. Thereby, cancer risk identification, screening and early detection are imperative for both the military health care beneficiaries and the population as a whole. In this review, we will focus on several pathogens and their potential roles in development of CRC, highlighting the clinical trials evaluating this correlation and provide our personal opinion about the importance of risk reduction, health promotion and disease prevention for military health care beneficiaries.
The Journal of Trauma: Injury, Infection, and Critical Care, 2011
Despite advances in resuscitation and surgical management of combat wounds, infection remains a c... more Despite advances in resuscitation and surgical management of combat wounds, infection remains a concerning and potentially preventable complication of combat-related injuries. Interventions currently used to prevent these infections have not been either clearly defined or subjected to rigorous clinical trials. Current infection prevention measures and wound management practices are derived from retrospective review of wartime experiences, from civilian trauma data, and from in vitro and animal data. This update to the guidelines published in 2008 incorporates evidence that has become available since 2007. These guidelines focus on care provided within hours to days of injury, chiefly within the combat zone, to those combat-injured patients with open wounds or burns. New in this update are a consolidation of antimicrobial agent recommendations to a backbone of high-dose cefazolin with or without metronidazole for most postinjury indications, and recommendations for redosing of antimicrobial agents, for use of negative pressure wound therapy, and for oxygen supplementation in flight.
The Journal of Trauma: Injury, Infection, and Critical Care, 2010
Infections caused by multidrug-resistant organisms (MDROs), including Acinetobacter, have complic... more Infections caused by multidrug-resistant organisms (MDROs), including Acinetobacter, have complicated the care of military personnel injured in Operations Iraqi and Enduring Freedom. Cumulative data suggest that nosocomial transmission of MDROs in deployed medical treatment facilities (MTFs) has contributed to these infections. A 2008 review of deployed MTFs identified multiple factors impeding the performance of infection prevention and control (IC) practices. In response, efforts to emphasize IC basics, improve expertise, and better track MDRO colonization were pursued. Efforts to increase awareness and enhance IC in deployed MTFs were focused on educating leaders and deploying personnel, producing deployed IC resources, and standardizing level IV and V admission screening for MDRO colonization. A repeat mission in 2009 reviewed interval progress. Increased awareness and the need for emphasis on basic IC practice, including hand hygiene, use of transmission-based (isolation) precautions, and cohorting of patients, were imparted to leaders and deploying personnel through briefings, presentations, and an All Army Activities message. Enhancement of IC expertise was implemented through increased standardization of IC practice, establishment of a predeployment IC short course, an IC teleconsultation service, and dedicated Internet resources. Standardization of admission colonization screening of personnel evacuated from the combat theater was established to better define and respond to the MDRO problem. A repeat review of the deployed MTFs found overall improvement in IC practice, including clear command emphasis in the Iraqi theater of operations. Maintaining a strong IC effort in the deployed setting, even in a stabilized operational environment, is difficult. Use of innovative strategies to enhance expertise and practice were implemented to reduce MDRO infections.
In AIDS, nodular skin disease can result from various causes. To report a new manifestation of mi... more In AIDS, nodular skin disease can result from various causes. To report a new manifestation of microsporidial infection presenting as nodular skin disease with underlying osteomyelitis. Case report. Tertiary-care military medical center in Washington, D.C. A 36-year-old woman with late-stage AIDS who presented with disseminated, nodular cutaneous lesions and underlying osteomyelitis. Disseminated microsporidial infection with an Encephalitozoon-like species was diagnosed by electron microscopic examination of material obtained from the skin lesions. The patient received long-term oral clindamycin therapy, which cured her disseminated infection. Microsporidia can cause disseminated cutaneous infections in AIDS patients. The response of this patient to long-term clindamycin therapy merits further evaluation.
... Lancet. 1995;346:1190-3. 4. Ohrt C, Richie TL, Widjaja H, Shanks GD, Fitriadi J, Fryauff DJ, ... more ... Lancet. 1995;346:1190-3. 4. Ohrt C, Richie TL, Widjaja H, Shanks GD, Fitriadi J, Fryauff DJ, et al. Meffoquine compared with doxycycline for the prophylaxis of malaria in Indonesian soldiers. ... This question can be ad-dressed only in a prospective study such as ours. ...
Despite advances in resuscitation and surgical management of combat wounds, infection remains a c... more Despite advances in resuscitation and surgical management of combat wounds, infection remains a concerning and potentially preventable complication of combat-related injuries. Interventions currently used to prevent these infections have not been either clearly defined or subjected to rigorous clinical trials. Current infection prevention measures and wound management practices are derived from retrospective review of wartime experiences, from civilian trauma data, and from in vitro and animal data. This update to the guidelines published in 2008 incorporates evidence that has become available since 2007. These guidelines focus on care provided within hours to days of injury, chiefly within the combat zone, to those combat-injured patients with open wounds or burns. New in this update are a consolidation of antimicrobial agent recommendations to a backbone of high-dose cefazolin with or without metronidazole for most postinjury indications and recommendations for redosing of antimicrobial agents, for use of negative pressure wound therapy, and for oxygen supplementation in flight.
Background: Collection of multidrug-resistant organisms (MDRO) and aggregation of associated info... more Background: Collection of multidrug-resistant organisms (MDRO) and aggregation of associated information are essential to understanding the challenges, successes and failures the Army’s healthcare system faces in controlling the current epidemic of infections with these bacteria. Objective: Begin collection of these pathogens along the entire evacuation chain to enable spatial analysis and epidemiologic profiling necessary to determine attributable origins, patterns of spread, and mechanisms of resistance. Methods: In June 2009, the Army Medical Command authorized the Walter Reed Army Institute of Research to establish the MRSN, consisting of a microbiology laboratory, repository and an Army-wide surveillance network. Army hospitals submit all MDRO encountered during healthcare delivery and active surveillance to the network repository, along with the associated clinical-demographic information. The repository determines their genetic relatedness, performs extended phenotypic and ph...
The American Journal of Tropical Medicine and Hygiene, 2006
We conducted a phase 1 trial of candidate malaria vaccine RTS,S/AS02A in western Kenya to determi... more We conducted a phase 1 trial of candidate malaria vaccine RTS,S/AS02A in western Kenya to determine its safety and immunogenicity in healthy adults in an area hyperendemic for malaria. Twenty adults were enrolled and received RTS,S/AS02A (50 g of RTS,S in 0.5 mL of AS02A) by intramuscular injection on a 0-, 28-, and 178-day schedule. All 60 scheduled immunizations were given, and 18 of 20 volunteers completed the last study visit on day 210. The vaccine was safe and well-tolerated. There were no vaccine-related severe adverse events. The most common solicited adverse events associated with immunization were injection site pain and headache. The geometric mean concentration of antibodies to circumsporozoite protein was 1.9 g/mL at baseline and it increased 2-4 weeks after each dose to 16, 17.8, and 36.6 g/mL, respectively. These safety and immunogenicity data from adults in hyperendemic Kenya are comparable to data reported earlier from two trials in west African adults in hypo-endemic and meso-endemic areas of The Gambia. We conclude that in this small study, RTS,S/AS02A is safe and similarly immunogenic in malaria-exposed African adults of different ethnicity in different transmission settings.
Background Bordetella pertussis is one of the leading causes of vaccine preventable death and mor... more Background Bordetella pertussis is one of the leading causes of vaccine preventable death and morbidity globally. Over the last 20 years, pertussis has resurged worldwide, even in territories with high immunization coverage. To improve vaccine strategies, a greater understanding of human B. pertussis infection and immunity is required. This study aims to develop a safe controlled human B. pertussis infection model and to define natural immune responses against wild-type B. pertussis in order to facilitate the development of bioassays and next-generation pertussis vaccines. Methods In this first-in-human controlled infection model, healthy volunteers aged 18–45 years with an anti-pertussis toxin (PT) IgG level of <20 IU/mL were inoculated intranasally with B. pertussis strain B1917. Safety, colonization, and shedding were monitored over a 17-day inpatient period. Colonization was assessed by culture and qPCR of nasal washes and nasopharyngeal swabs. Azithromycin eradication therap...
We summarise an ethically approved protocol for the development of an experimental human challeng... more We summarise an ethically approved protocol for the development of an experimental human challenge colonisation model. Globally Bordetella pertussis is one of the leading causes of vaccine-preventable death. Many countries have replaced whole cell vaccines with acellular vaccines over the last 20 years during which pertussis appears to be resurgent in a number of countries in the developed world that boast high immunisation coverage. The acellular vaccine provides relatively short-lived immunity and, in contrast to whole cell vaccines, may be less effective against colonisation and subsequent transmission. To improve vaccine strategies, a greater understanding of human B. pertussis colonisation is required. This article summarises a protocol and does not contain any results. A controlled human colonisation model will be developed over two phases. In phase A, a low dose of the inoculum will be given intranasally to healthy participants. This dose will be escalated or de-escalated unt...
The RTS,S candidate malaria vaccine can protect against controlled human malaria infection (CHMI)... more The RTS,S candidate malaria vaccine can protect against controlled human malaria infection (CHMI), but how protection is achieved remains unclear. Here, we have analyzed longitudinal peripheral blood transcriptome and immunogenicity data from a clinical efficacy trial in which healthy adults received three RTS,S doses 4 weeks apart followed by CHMI 2 weeks later. Multiway partial least squares discriminant analysis (N-PLS-DA) of transcriptome data identified 110 genes that could be used in predictive models of protection. Among the 110 genes, 42 had known immune-related functions, including 29 that were related to the NF-κB-signaling pathway and 14 to the IFN-γ-signaling pathway. Post-dose 3 serum IFN-γ concentrations were also correlated with protection; and N-PLS-DA of IFN-γ-signaling pathway transcriptome data selected almost all (44/45) of the representative genes for predictive models of protection. Hence, the identification of the NF-κB and IFN-γ pathways provides further insi...
ABSTRACT Background: Collection of multidrug-resistant organisms (MDRO) and aggregation of associ... more ABSTRACT Background: Collection of multidrug-resistant organisms (MDRO) and aggregation of associated information are essential to understanding the challenges, successes and failures the Army’s healthcare system faces in controlling the current epidemic of infections with these bacteria. Objective: Begin collection of these pathogens along the entire evacuation chain to enable spatial analysis and epidemiologic profiling necessary to determine attributable origins, patterns of spread, and mechanisms of resistance. Methods: In June 2009, the Army Medical Command authorized the Walter Reed Army Institute of Research to establish the MRSN, consisting of a microbiology laboratory, repository and an Army-wide surveillance network. Army hospitals submit all MDRO encountered during healthcare delivery and active surveillance to the network repository, along with the associated clinical-demographic information. The repository determines their genetic relatedness, performs extended phenotypic and phylogenetic analyses, and preserves them indefinitely. Analogous to successful civilian programs, monitoring and feedback of infection control components along with site visits comprise key tenets of the MRSN. Results: Site assistance visits to stateside and overseas facilities were conducted. By October 2009, over 800 MDRO from three major military referral centers were collected, centralized and are currently undergoing clonal analysis. The MRSN also assisted in one outbreak investigation. The first of the monthly reports to healthcare policy makers and infection preventionists will be issued in December 2009. Ultimately, facility specific, regional and global antibiograms along with other epidemiologic data will be made available on a secure web-enabled database. Archived isolates will be available to investigators. Conclusions: System-wide active surveillance, standardized characterization and centralized archiving of these organisms may enhance infection prevention and control efforts and earlier detection of outbreaks. Opportunities for future collaboration with HHS and the VA will be discussed.
The Transformation of Academic Health Centers, 2015
The past 12 years of armed conflict in Iraq and Afghanistan have required the Department of Defen... more The past 12 years of armed conflict in Iraq and Afghanistan have required the Department of Defense’s Military Health System to consider new ways to assess and implement approaches to combat injuries for which older methods proved to be inadequate. We provide several examples that, while not subjected to traditional randomized control trials, have been rigorously evaluated and implemented. This focused empiricism has resulted in the lowest died-of-wounds rate in the history of warfare. Many of these developments have already been incorporated into civilian practice. Moreover, the focused, empirical approach may offer an alternative means of carefully evaluating novel modalities where randomized controlled trials are impractical.
Colorectal cancer (CRC) is a major burden to healthcare systems worldwide accounting for approxim... more Colorectal cancer (CRC) is a major burden to healthcare systems worldwide accounting for approximately one million of new cancer cases worldwide. Even though, CRC mortality has decreased over the last 20 years, it remains the third most common cause of cancer-related mortality, accounting for approximately 600,000 deaths in 2008 worldwide. A multitude of risk factors have been linked to CRC, including hereditary factors, environmental factors and inflammatory syndromes affecting the gastrointestinal tract. Recently, various pathogens were added to the growing list of risk factors for a number of common epithelial cancers, but despite the multitude of correlative studies, only suggestions remain about the possible relationship between selected viruses and bacteria of interest and the CRC risk. United States military service members are exposed to various risk factors impacting the incidence of cancer development. These exposures are often different from that of many sectors of the civilian population. Thereby, cancer risk identification, screening and early detection are imperative for both the military health care beneficiaries and the population as a whole. In this review, we will focus on several pathogens and their potential roles in development of CRC, highlighting the clinical trials evaluating this correlation and provide our personal opinion about the importance of risk reduction, health promotion and disease prevention for military health care beneficiaries.
The Journal of Trauma: Injury, Infection, and Critical Care, 2011
Despite advances in resuscitation and surgical management of combat wounds, infection remains a c... more Despite advances in resuscitation and surgical management of combat wounds, infection remains a concerning and potentially preventable complication of combat-related injuries. Interventions currently used to prevent these infections have not been either clearly defined or subjected to rigorous clinical trials. Current infection prevention measures and wound management practices are derived from retrospective review of wartime experiences, from civilian trauma data, and from in vitro and animal data. This update to the guidelines published in 2008 incorporates evidence that has become available since 2007. These guidelines focus on care provided within hours to days of injury, chiefly within the combat zone, to those combat-injured patients with open wounds or burns. New in this update are a consolidation of antimicrobial agent recommendations to a backbone of high-dose cefazolin with or without metronidazole for most postinjury indications, and recommendations for redosing of antimicrobial agents, for use of negative pressure wound therapy, and for oxygen supplementation in flight.
The Journal of Trauma: Injury, Infection, and Critical Care, 2010
Infections caused by multidrug-resistant organisms (MDROs), including Acinetobacter, have complic... more Infections caused by multidrug-resistant organisms (MDROs), including Acinetobacter, have complicated the care of military personnel injured in Operations Iraqi and Enduring Freedom. Cumulative data suggest that nosocomial transmission of MDROs in deployed medical treatment facilities (MTFs) has contributed to these infections. A 2008 review of deployed MTFs identified multiple factors impeding the performance of infection prevention and control (IC) practices. In response, efforts to emphasize IC basics, improve expertise, and better track MDRO colonization were pursued. Efforts to increase awareness and enhance IC in deployed MTFs were focused on educating leaders and deploying personnel, producing deployed IC resources, and standardizing level IV and V admission screening for MDRO colonization. A repeat mission in 2009 reviewed interval progress. Increased awareness and the need for emphasis on basic IC practice, including hand hygiene, use of transmission-based (isolation) precautions, and cohorting of patients, were imparted to leaders and deploying personnel through briefings, presentations, and an All Army Activities message. Enhancement of IC expertise was implemented through increased standardization of IC practice, establishment of a predeployment IC short course, an IC teleconsultation service, and dedicated Internet resources. Standardization of admission colonization screening of personnel evacuated from the combat theater was established to better define and respond to the MDRO problem. A repeat review of the deployed MTFs found overall improvement in IC practice, including clear command emphasis in the Iraqi theater of operations. Maintaining a strong IC effort in the deployed setting, even in a stabilized operational environment, is difficult. Use of innovative strategies to enhance expertise and practice were implemented to reduce MDRO infections.
In AIDS, nodular skin disease can result from various causes. To report a new manifestation of mi... more In AIDS, nodular skin disease can result from various causes. To report a new manifestation of microsporidial infection presenting as nodular skin disease with underlying osteomyelitis. Case report. Tertiary-care military medical center in Washington, D.C. A 36-year-old woman with late-stage AIDS who presented with disseminated, nodular cutaneous lesions and underlying osteomyelitis. Disseminated microsporidial infection with an Encephalitozoon-like species was diagnosed by electron microscopic examination of material obtained from the skin lesions. The patient received long-term oral clindamycin therapy, which cured her disseminated infection. Microsporidia can cause disseminated cutaneous infections in AIDS patients. The response of this patient to long-term clindamycin therapy merits further evaluation.
... Lancet. 1995;346:1190-3. 4. Ohrt C, Richie TL, Widjaja H, Shanks GD, Fitriadi J, Fryauff DJ, ... more ... Lancet. 1995;346:1190-3. 4. Ohrt C, Richie TL, Widjaja H, Shanks GD, Fitriadi J, Fryauff DJ, et al. Meffoquine compared with doxycycline for the prophylaxis of malaria in Indonesian soldiers. ... This question can be ad-dressed only in a prospective study such as ours. ...
Despite advances in resuscitation and surgical management of combat wounds, infection remains a c... more Despite advances in resuscitation and surgical management of combat wounds, infection remains a concerning and potentially preventable complication of combat-related injuries. Interventions currently used to prevent these infections have not been either clearly defined or subjected to rigorous clinical trials. Current infection prevention measures and wound management practices are derived from retrospective review of wartime experiences, from civilian trauma data, and from in vitro and animal data. This update to the guidelines published in 2008 incorporates evidence that has become available since 2007. These guidelines focus on care provided within hours to days of injury, chiefly within the combat zone, to those combat-injured patients with open wounds or burns. New in this update are a consolidation of antimicrobial agent recommendations to a backbone of high-dose cefazolin with or without metronidazole for most postinjury indications and recommendations for redosing of antimicrobial agents, for use of negative pressure wound therapy, and for oxygen supplementation in flight.
Background: Collection of multidrug-resistant organisms (MDRO) and aggregation of associated info... more Background: Collection of multidrug-resistant organisms (MDRO) and aggregation of associated information are essential to understanding the challenges, successes and failures the Army’s healthcare system faces in controlling the current epidemic of infections with these bacteria. Objective: Begin collection of these pathogens along the entire evacuation chain to enable spatial analysis and epidemiologic profiling necessary to determine attributable origins, patterns of spread, and mechanisms of resistance. Methods: In June 2009, the Army Medical Command authorized the Walter Reed Army Institute of Research to establish the MRSN, consisting of a microbiology laboratory, repository and an Army-wide surveillance network. Army hospitals submit all MDRO encountered during healthcare delivery and active surveillance to the network repository, along with the associated clinical-demographic information. The repository determines their genetic relatedness, performs extended phenotypic and ph...
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Papers by Kent Kester