{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T20:34:22Z","timestamp":1791923662843,"version":"4.3.4"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"Supplement_6","funder":[{"DOI":"10.13039\/100006492","name":"Division of Intramural Research, National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","award":["Y1-AI-5072"],"award-info":[{"award-number":["Y1-AI-5072"]}],"id":[{"id":"10.13039\/100006492","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Defense Health Program","award":["HU0001190002"],"award-info":[{"award-number":["HU0001190002"]}]},{"name":"Military Infectious Diseases Research Program","award":["HU0001-18-20035"],"award-info":[{"award-number":["HU0001-18-20035"]}]},{"name":"Department of Navy, Wounded, Ill, and Injured Program","award":["HU0001-10-1-0014"],"award-info":[{"award-number":["HU0001-10-1-0014"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Battlefield-related wound infections are a significant source of morbidity among combat casualties. Seasonality of these infections was demonstrated in previous conflicts (e.g., Korea) but has not been described with trauma-related health care\u2013associated infections from the war in Afghanistan.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>The study population included military personnel wounded in Afghanistan (2009-2014) medevac\u2019d to Landstuhl Regional Medical Center and transitioned to participating military hospitals in the United States with clinical suspicion of wound infections and wound cultures collected \u22647\u2009days post-injury. Analysis was limited to the first wound culture from individuals. Infecting isolates were collected from skin and soft-tissue infections, osteomyelitis, and burn soft-tissue infections. Data were analyzed by season (winter [ December 1-February 28\/29], spring [March 1-May 31], summer [June 1-August 31], and fall [September 1-November 30]).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Among 316 patients, 297 (94.0%) sustained blast injuries with a median injury severity score and days from injury to initial culture of 33 and 3.5, respectively. Although all patients had a clinical suspicion of a wound infection, a diagnosis was confirmed in 198 (63%) patients. Gram-negative bacilli (59.5% of 316) were more commonly isolated from wound cultures in summer (68.1%) and fall (67.1%) versus winter (43.9%) and spring (45.1%; P\u2009&amp;lt;\u2009.001). Multidrug-resistant (MDR) Gram-negative bacilli (21.8%) were more common in summer (21.8%) and fall (30.6%) versus winter (7.3%) and spring (19.7%; P\u2009=\u2009.028). Findings were similar for infecting Gram-negative bacilli (72.7% of 198)\u2014summer (79.5%) and fall (83.6%; P\u2009=\u2009.001)\u2014and infecting MDR Gram-negative bacilli (27.3% of 198)\u2014summer (25.6%) and fall (41.8%; P\u2009=\u2009.015). Infecting anaerobes were more common in winter (40%) compared to fall (11%; P\u2009=\u2009.036). Gram-positive organisms were not significantly different by season.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Gram-negative bacilli, including infecting MDR Gram-negative bacilli, were more commonly recovered in summer\/fall months from service members injured in Afghanistan. This may have implications for empiric antibiotic coverage during these months.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usad115","type":"journal-article","created":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T15:05:15Z","timestamp":1699628715000},"page":"304-310","source":"Crossref","is-referenced-by-count":9,"title":["Seasonality of Microbiology of Combat-Related Wounds and Wound Infections in Afghanistan"],"prefix":"10.1093","volume":"188","author":[{"given":"Matthew A","family":"Soderstrom","sequence":"first","affiliation":[{"name":"Infectious Disease Service, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston , TX 78234, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana M","family":"Blyth","sequence":"additional","affiliation":[{"name":"Infectious Disease Service, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M Leigh","family":"Carson","sequence":"additional","affiliation":[{"name":"Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD 20817, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wesley R","family":"Campbell","sequence":"additional","affiliation":[{"name":"Infectious Disease Service, Walter Reed National Military Medical Center , Bethesda, MD 20889, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph M","family":"Yabes","sequence":"additional","affiliation":[{"name":"Infectious Disease Service, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston , TX 78234, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Faraz","family":"Shaikh","sequence":"additional","affiliation":[{"name":"Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD 20817, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laveta","family":"Stewart","sequence":"additional","affiliation":[{"name":"Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"},{"name":"Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. , Bethesda, MD 20817, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David R","family":"Tribble","sequence":"additional","affiliation":[{"name":"Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences , Bethesda, MD 20814, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clinton K","family":"Murray","sequence":"additional","affiliation":[{"name":"Infectious Disease Service, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston , TX 78234, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John L","family":"Kiley","sequence":"additional","affiliation":[{"name":"Infectious Disease Service, Brooke Army Medical Center, Joint Base San Antonio, Fort Sam Houston , TX 78234, 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