The Invisible Enemy in Iraq is a normally innocuous bacterium — Acinetobacter baumannii — that has become resistant to most antibiotics, killed immune-compromised troops after surgery, and spread to the wider healthcare community:
The wounded soldiers were not smuggling bacteria from the desert into military hospitals after all. Instead, they were picking it up there. The evacuation chain itself had become the primary source of infection. By creating the most heroic and efficient means of saving lives in the history of warfare, the Pentagon had accidentally invented a machine for accelerating bacterial evolution and was airlifting the pathogens halfway around the world.To stem the outbreak at its source, the epicon team proposed sweeping reforms throughout the combat zone. The CSHs had to be run more like real hospitals, with frequent scrub-downs, stringent hand-washing, and HEPA filters to clean the air. The dead tissue surrounding “frag” wounds turned out to be an ideal colonization site for the bugs, so it had to be removed more aggressively up front. “If you don’t have that necrotic tissue, your own innate defenses help keep the wound clean,” says Kim Moran, a tropical-disease specialist who assisted the investigation when she worked at Walter Reed. Wound dressings needed to be changed less often, so bacteria from the hospital environment had less opportunity to get in. And the broad-spectrum antibiotics had to be reserved for the treatment of identified bugs.