BACKGROUND
VAP is a common healthcare-associated infection (HAI), but what defines VAP and how it is diagnosed have remained moving targets. Due to wide variations in the surveillance and diagnosis of VAP, the true rate of VAP is unknown, but it is believed to occur in at least 5-15% of patients placed on a ventilator.1-2
While much of combat casualty care in the intensive care unit setting is largely similar to the care of trauma patients in civilian centers, there are several challenges unique to expeditionary care, chief among them being microbiological variabilities. Military operations in Iraq and Afghanistan are notable for a high number of multi-drug resistant (MDR) bacterial infections in combat casualties, particularly Acinetobacter calcoaceticus-baumannii complex (ABC).3
Several benchmark studies, along with other data, implicate nosocomial transmission as the major contributing source of these infections.4-6 An outbreak of multi-drug resistant Acinetobacter baumannii-calcoaceticus complex infections in the U.S. military health-care system associated with military operations in Iraq described cluster outbreak strains of ABC within the military healthcare system suggesting that, at least in the case of ABC, the bacteria has spread from field hospitals in Iraq to those within the continental U.S.7 Additionally, bacteria identical to those found in clinical isolates have been cultured from numerous environmental surfaces from U.S. medical treatment facilities within Iraq. These experiences have been replicated in more recent times with similar results, indicating that this issue is endemic and not related to individuals or groups of service members.