Prehospital and Disaster Medicine

Original Research

Amount of Usage and Involvement in Explosions Not Associated with Increased Contamination of Prehospital Vehicles with Multi-drug-resistant Organisms

Emil Leshoa1 c1, Julie Akea2, Xiao-Zhe Huanga2, Dana M. Casha2, Mikeljon Nikolicha2, Melissa Barbera3, Kathleen Robensa4, Eric Garnetta5, Luther Lindlera6 and Paul Scotta1

a1 2nd Brigade Combat Team, 3rd Infantry Division, US Army, Iraq. Dr. Lesho is currently affiliated with the Walter Reed Army Institute of Research, Silver Spring, Maryland USA

a2 Walter Reed Army Institute of Research, Silver Spring, Maryland USA

a3 Infectious Diseases Laboratory Service, Walter Reed National Military Medical Center, Bethesda, Maryland, USA

a4 Montgomery County Education Association, Rockville, Maryland USA

a5 948th Forward Surgical Team, US Army, Al Kut, Iraq

a6 Armed Forces Health Surveillance Center, Silver Spring, Maryland USA


Introduction The role of explosions and patient transport vehicles as sources and vectors of Gram-negative, multidrug-resistant organisms (MDROs) that predominate infections following lengthy evacuations after disasters due to natural hazards and in current war-trauma patients is unknown.

Hypothesis/Problem Damaged or heavily-used vehicles could be sources of the MDROs subsequently linked to nosocomial infections.

Methods From January through May 2008 in Iraq, inside surfaces of heavily-used, tactical vehicles (Experimental Group) were sampled with sterile, pre-moistened swabs. Swabs, along with positive and negative controls, were shipped to the reference laboratory in Washington, DC, where they underwent culture, identification and susceptibility testing, and pulsed-field gel electrophoresis. Multidrug-resistant organisms were defined according to the standard Centers for Disease Control and Prevention definitions. High risk organisms (HROs) were defined as susceptible E. coli, A. baumannii, P. aeruginosa, Enterobacter spp, or Klebsiella spp. Concurrently, new counterparts (Control Group) were similarly surveyed in a storage lot in Georgia, USA. Groups were compared using the Chi-squared test.

Results One hundred thirty-nine consecutive vehicles including all available ambulances were sampled, yielding 153 swabs. Nineteen were lost or damaged during shipping. Seventy-nine swabs yielded growth of one or more Gram-negative bacteria. The amount and genotype of MDROs in heavily-used vehicles, including those involved in roadside bombings, were compared to control vehicles and to strains isolated from wounds and environmental surfaces at the base hospital. Predominant organisms included P. agglomerans (34%), S. flexneri (8%), E. vulneris (6%), Pseudomonas sp. (6%), and K. pneumonia (6%). No MDROs were isolated. Thirteen vehicles (eight of 94 experimental and five of 45 control) yielded HRO. There was no difference in contamination rates (P = .63). No HROs were isolated from ambulances. No clonal association existed between vehicle and hospital strains.

Conclusion Given the implications that this knowledge gap has on military and civilian prehospital reservoirs of infection, further study is warranted to confirm these findings and identify targets for preventive intervention throughout civilian disaster and military casualty evacuation chains.

E Lesho, J Ake, X Huang, DM Cash, M Nikolich, M Barber, K Robens, E Garnett, L Lindler, P Scott. Amount of usage and involvement in explosions not associated with increased contamination of prehospital vehicles with multi-drug-resistant organisms. Prehosp Disaster Med. 2013;28(2):1-3..

(Received April 15 2011)

(Accepted August 15 2011)

(Online publication January 07 2013)


  • evacuation;
  • disaster;
  • high-risk organism;
  • infection;
  • methicillin-resistant Staphlococcus aureus ;
  • military;
  • MRSA;
  • multidrug-resistant organism;
  • prehospital


c1 Correspondence: Emil Lesho, DO 2209 Parker Avenue Silver Spring, MD 20902 USA E-mail