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  1. Article ; Online: Field Wound Care: Prophylactic Antibiotics.

    Murray, Clinton K

    Wilderness & environmental medicine

    2017  Volume 28, Issue 2S, Page(s) S90–S102

    Abstract: Adequate management of wounds requires numerous interventions, one of which is the appropriate use of antimicrobials to attempt to minimize the risk of excess morbidity or mortality without increasing toxicity or multidrug resistant bacterial acquisition. ...

    Abstract Adequate management of wounds requires numerous interventions, one of which is the appropriate use of antimicrobials to attempt to minimize the risk of excess morbidity or mortality without increasing toxicity or multidrug resistant bacterial acquisition. There are numerous recommendations and opinions for not only the use of systemic prophylactic antimicrobials, but also the agent, dose, route, and duration. To best address the implementation of systemic antimicrobials in a field scenario, one must weigh the factors that go into that decision and then determine the best agents possible. The epidemiologic triangle (ie, the host, the agent, and the environment) forms the basis for selecting the correct prophylactic antibiotic for field wound care. Extreme conditions can be encountered in both military and nonmilitary systems, requiring a unique selection process to make the right antibiotic choice. A modifiable weighted matrix, recommended previously for point of injury combat casualty care, assists in selecting the best oral and intravenous/intramuscular agent based on the epidemiologic risk determination.
    Language English
    Publishing date 2017-06
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 1238909-2
    ISSN 1545-1534 ; 1080-6032
    ISSN (online) 1545-1534
    ISSN 1080-6032
    DOI 10.1016/j.wem.2016.12.009
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: Corrigendum: Bactericidal Property of Oregano Oil Against Multidrug-Resistant Clinical Isolates.

    Lu, Min / Dai, Tianhong / Murray, Clinton K / Wu, Mei X

    Frontiers in microbiology

    2021  Volume 12, Page(s) 713573

    Abstract: This corrects the article DOI: 10.3389/fmicb.2018.02329.]. ...

    Abstract [This corrects the article DOI: 10.3389/fmicb.2018.02329.].
    Language English
    Publishing date 2021-07-12
    Publishing country Switzerland
    Document type Published Erratum
    ZDB-ID 2587354-4
    ISSN 1664-302X
    ISSN 1664-302X
    DOI 10.3389/fmicb.2021.713573
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article ; Online: Immune interference revisited: Impact of live-attenuated influenza vaccine prior to yellow fever vaccination.

    Blyth, Dana M / Liang, Zhaodong / Williams, Maya / Murray, Clinton K

    Vaccine

    2022  Volume 40, Issue 6, Page(s) 961–966

    Abstract: Background: During routine mass live-attenuated influenza vaccination (LAIV) for military personnel, emergent deployment for Ebola humanitarian assistance (OUA) required mass yellow fever vaccination (YF17D), often < 4-weeks recommended timing post-LAIV- ...

    Abstract Background: During routine mass live-attenuated influenza vaccination (LAIV) for military personnel, emergent deployment for Ebola humanitarian assistance (OUA) required mass yellow fever vaccination (YF17D), often < 4-weeks recommended timing post-LAIV-triggering concerns for immune interference. We compared YF17D seroconversion rates in personnel who received YF17D as recommended (vaccinated by guidelines [VBG]) to those who received the vaccine outside the recommended timing following LAIV (not vaccinated by guidelines [NVBG]).
    Methods: OUA deploying personnel who received LAIV simultaneously or before YF17D and had pre- and post-vaccination archived serum were included. VBG was defined as YF17D given concurrently or ≥ 30 days post-LAIV and NVBG as YF17D given 1-29 days post-LAIV. YF17D seroresponse was determined by screening ELISA confirmed with plaque reduction neutralization testing (PRNT) on positive ELISA samples. Exclusion criteria were prior YF17D and pre-vaccination YF17D positive PRNT.
    Results: Of the 660 personnel included, 507 were VBG and 153 were NVBG. Median age was 25 years for both groups. Men accounted for 84% of those VBG and 79% NVBG (p = 0.194). Seroconversion rates were 97.8% for VBG and 95.4% for NVBG (p = 0.15). Multivariate logistic regression revealed that YF17D on days 7-21 post-LAIV (adjusted odds ratio [aOR] 0.304, p = 0.017; confidence interval [CI] 0.114-0.810) and female sex (aOR 0.330, p = 0.026; CI 0.124-0.879) were associated with decreased seroresponse.
    Conclusions: In this healthy, young adult military population, there was high seroconversion following YF17D when administered simultaneously and at various time points after LAIV. Slight decreases in seroresponse were seen in women and those receiving YF17D 7-21 days following LAIV.
    MeSH term(s) Adult ; Female ; Humans ; Influenza Vaccines ; Influenza, Human ; Male ; Vaccination ; Vaccines, Attenuated ; Yellow Fever ; Young Adult
    Chemical Substances Influenza Vaccines ; Vaccines, Attenuated
    Language English
    Publishing date 2022-01-12
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 605674-x
    ISSN 1873-2518 ; 0264-410X
    ISSN (online) 1873-2518
    ISSN 0264-410X
    DOI 10.1016/j.vaccine.2021.12.031
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: Prognostic Value of Sequential Organ Failure Assessment (SOFA) Score in Critically-Ill Combat-Injured Patients.

    McCarthy, Shannon L / Stewart, Laveta / Shaikh, Faraz / Murray, Clinton K / Tribble, David R / Blyth, Dana M

    Journal of intensive care medicine

    2022  Volume 37, Issue 11, Page(s) 1426–1434

    Abstract: Background: ...

    Abstract Background:
    MeSH term(s) Critical Illness ; Humans ; Intensive Care Units ; Male ; Organ Dysfunction Scores ; Prognosis ; ROC Curve ; Retrospective Studies ; Sepsis/diagnosis
    Language English
    Publishing date 2022-02-16
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632828-3
    ISSN 1525-1489 ; 0885-0666
    ISSN (online) 1525-1489
    ISSN 0885-0666
    DOI 10.1177/08850666221078196
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article ; Online: Department of Defense Trauma Registry Infectious Disease Module Impact on Clinical Practice.

    Tribble, David R / Spott, Mary Ann / Shackleford, Stacey A / Gurney, Jennifer M / Murray, Bg Clinton K

    Military medicine

    2022  Volume 187, Issue Suppl 2, Page(s) 7–16

    Abstract: Background: The Joint Trauma System (JTS) is a DoD Center of Excellence for Military Health System trauma care delivery and the DoD's reference body for trauma care in accordance with National Defense Authorization Act for Fiscal Year 2017. Through the ... ...

    Abstract Background: The Joint Trauma System (JTS) is a DoD Center of Excellence for Military Health System trauma care delivery and the DoD's reference body for trauma care in accordance with National Defense Authorization Act for Fiscal Year 2017. Through the JTS, evidence-based clinical practice guidelines (CPGs) have been developed and subsequently refined to standardize and improve combat casualty care. Data are amassed through a single, centralized DoD Trauma Registry to support process improvement measures with specialty modules established as the registry evolved. Herein, we review the implementation of the JTS DoD Trauma Registry specialty Infectious Disease Module and the development of infection-related CPGs and summarize published findings on the subsequent impact of the Infectious Disease Module on combat casualty care clinical practice and guidelines.
    Methods: The DoD Trauma Registry Infectious Disease Module was developed in collaboration with the Infectious Disease Clinical Research Program (IDCRP) Trauma Infectious Disease Outcomes Study (TIDOS). Infection-related information (e.g., syndromes, antibiotic management, and microbiology) were collected from military personnel wounded during deployment June 1, 2009 through December 31, 2014 and medevac'd to Landstuhl Regional Medical Center in Germany before transitioning to participating military hospitals in the USA.
    Results: To support process improvements and reduce variation in practice patterns, data collected through the Infectious Disease Module have been utilized in TIDOS analyses focused on assessing compliance with post-trauma antibiotic prophylaxis recommendations detailed in JTS CPGs. Analyses examined compliance over three time periods: 6 months, one-year, and 5 years. The five-year analysis demonstrated significantly improved adherence to recommendations following the dissemination of the 2011 JTS CPG, particularly with open fractures (34% compliance compared to 73% in 2013-2014). Due to conflicting recommendations regarding use of expanded Gram-negative coverage with open fractures, infectious outcomes among patients with open fractures who received cefazolin or expanded Gram-negative coverage (cefazolin plus fluoroquinolones and/or aminoglycosides) were also examined in a TIDOS analysis. The lack of a difference in the proportion of osteomyelitis (8% in both groups) and the significantly greater recovery of Gram-negative organisms resistant to aminoglycosides or fluoroquinolones among patients who received expanded Gram-negative coverage supported JTS recommendations regarding the use of cefazolin with open fractures. Following recognition of the outbreak of invasive fungal wound infections (IFIs) among blast casualties injured in Afghanistan, the ID Module was refined to capture data (e.g., fungal culture and histopathology findings, wound necrosis, and antifungal management) needed for the TIDOS team to lead the DoD outbreak investigation. These data captured through the Infectious Disease Module provided support for the development of a JTS CPG for the prevention and management of IFIs, which was later refined based on subsequent TIDOS IFI analyses.
    Conclusions: To improve combat casualty care outcomes and mitigate high-consequence infections in future conflicts, particularly in the event of prolonged field care, expansion, refinement, and a mechanism for sustainability of the DoD Trauma Registry Infectious Disease Module is needed to include real-time surveillance of infectious disease trends and outcomes.
    MeSH term(s) Aminoglycosides ; Anti-Bacterial Agents/therapeutic use ; Cefazolin/therapeutic use ; Communicable Diseases ; Fluoroquinolones ; Fractures, Open ; Humans ; Military Personnel ; Registries ; United States/epidemiology
    Chemical Substances Aminoglycosides ; Anti-Bacterial Agents ; Fluoroquinolones ; Cefazolin (IHS69L0Y4T)
    Language English
    Publishing date 2022-05-05
    Publishing country England
    Document type Journal Article ; Review ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, N.I.H., Extramural
    ZDB-ID 391061-1
    ISSN 1930-613X ; 0026-4075
    ISSN (online) 1930-613X
    ISSN 0026-4075
    DOI 10.1093/milmed/usac050
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: IDCRP Combat-Related Extremity Wound Infection Research.

    Petfield, Joseph L / Lewandowski, Louis R / Stewart, Laveta / Murray, Clinton K / Tribble, David R

    Military medicine

    2022  Volume 187, Issue Suppl 2, Page(s) 25–33

    Abstract: Introduction: Extremity trauma is the most common battlefield injury, resulting in a high frequency of combat-related extremity wound infections (CEWIs). As these infections are associated with substantial morbidity and may impact wounded warriors long ... ...

    Abstract Introduction: Extremity trauma is the most common battlefield injury, resulting in a high frequency of combat-related extremity wound infections (CEWIs). As these infections are associated with substantial morbidity and may impact wounded warriors long after initial hospitalization, CEWIs have been a focus of the Infectious Disease Clinical Research Program (IDCRP). Herein, we review findings of CEWI research conducted through the IDCRP and discuss future and ongoing analyses.
    Methods: Military personnel with deployment-related trauma sustained between 2009 and 2014 were examined in retrospective analyses through the observational Trauma Infectious Disease Outcomes Study (TIDOS). Characteristics of wounded warriors with ≥1 open extremity wound were assessed, focusing on injury patterns and infection risk factors. Through a separate trauma-associated osteomyelitis study, military personnel with combat-related open fractures of the long bones (tibia, femur, and upper extremity) sustained between 2003 and 2009 were examined to identify osteomyelitis risk factors.
    Results: Among 1,271 wounded warriors with ≥1 open extremity wound, 16% were diagnosed with a CEWI. When assessed by their most severe extremity injury (i.e., amputation, open fracture, or open soft-tissue wound), patients with amputations had the highest proportion of infections (47% of 212 patients with traumatic amputations). Factors related to injury pattern, mechanism, and severity were independent predictors of CEWIs during initial hospitalization. Having a non-extremity infection at least 4 days before CEWI diagnosis was associated with reduced likelihood of CEWI development. After hospital discharge, 28% of patients with extremity trauma had a new or recurrent CEWI during follow-up. Risk factors for the development of CEWIs during follow-up included injury pattern, having either a CEWI or other infection during initial hospitalization, and receipt of antipseudomonal penicillin for ≥7 days. A reduced likelihood for CEWIs during follow-up was associated with a hospitalization duration of 15-30 days. Under the retrospective osteomyelitis risk factor analysis, patients developing osteomyelitis had higher open fracture severity based on Gustilo-Anderson (GA) and the Orthopaedic Trauma Association classification schemes and more frequent traumatic amputations compared to open fracture patients without osteomyelitis. Recurrence of osteomyelitis was also common (28% of patients with open tibia fractures had a recurrent episode). Although osteomyelitis risk factors differed between the tibia, femur, and upper extremity groups, sustaining an amputation, use of antibiotic beads, and being injured in the earlier years of the study (before significant practice pattern changes) were consistent predictors. Other risk factors included GA fracture severity ≥IIIb, blast injuries, foreign body at fracture site (with/without orthopedic implant), moderate/severe muscle damage and/or necrosis, and moderate/severe skin/soft-tissue damage. For upper extremity open fractures, initial stabilization following evacuation from the combat zone was associated with a reduced likelihood of osteomyelitis.
    Conclusions: Forthcoming studies will examine the effectiveness of common antibiotic regimens for managing extremity deep soft-tissue infections to improve clinical outcomes of combat casualties and support development of clinical practice guidelines for CEWI treatment. The long-term impact of extremity trauma and resultant infections will be further investigated through both Department of Defense and Veterans Affairs follow-up, as well as examination of the impact on comorbidities and mental health/social factors.
    MeSH term(s) Amputation, Traumatic/complications ; Anti-Bacterial Agents/therapeutic use ; Communicable Diseases/complications ; Extremities/injuries ; Fractures, Open/complications ; Fractures, Open/epidemiology ; Humans ; Military Personnel ; Osteomyelitis/complications ; Osteomyelitis/diagnosis ; Osteomyelitis/epidemiology ; Retrospective Studies ; Soft Tissue Injuries/complications ; Wound Infection/drug therapy ; Wound Infection/epidemiology
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2022-07-01
    Publishing country England
    Document type Journal Article ; Review ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, N.I.H., Extramural
    ZDB-ID 391061-1
    ISSN 1930-613X ; 0026-4075
    ISSN (online) 1930-613X
    ISSN 0026-4075
    DOI 10.1093/milmed/usab065
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  7. Article ; Online: Army Medical Department at War: Healthcare in a Complex World.

    Murray, Clinton K / Jones, Stephen L

    U.S. Army Medical Department journal

    2016  , Issue 2-16, Page(s) 199–208

    MeSH term(s) Delivery of Health Care/organization & administration ; Humans ; Military Medicine/organization & administration ; Military Personnel ; Warfare
    Language English
    Publishing date 2016-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2041937-5
    ISSN 1946-1968 ; 1524-0436
    ISSN (online) 1946-1968
    ISSN 1524-0436
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Does Topical Vancomycin Powder Use in Fracture Surgery Change Bacteriology and Antibiotic Susceptibilities? An Analysis of the VANCO Trial.

    Joshi, Manjari / O'Toole, Robert V / Carlini, Anthony R / Gary, Joshua L / Obremskey, William T / Murray, Clinton K / Gaski, Greg / Reid, J Spence / Degani, Yasmin / Taylor, Tara J / Collins, Susan C / Huang, Yanjie / Whiting, Paul S / Patterson, Joseph T / Lee, Olivia C / Castillo, Renan C

    Journal of orthopaedic trauma

    2024  Volume 38, Issue 4, Page(s) 183–189

    MeSH term(s) Female ; Humans ; Male ; Middle Aged ; Anti-Bacterial Agents ; Bacteriology ; Coagulase/pharmacology ; Coagulase/therapeutic use ; Methicillin/pharmacology ; Methicillin/therapeutic use ; Methicillin-Resistant Staphylococcus aureus ; Powders/pharmacology ; Prospective Studies ; Staphylococcal Infections/microbiology ; Staphylococcus aureus ; Surgical Wound Infection/drug therapy ; Surgical Wound Infection/epidemiology ; Surgical Wound Infection/prevention & control ; Vancomycin
    Chemical Substances Anti-Bacterial Agents ; Coagulase ; Methicillin (Q91FH1328A) ; Powders ; Vancomycin (6Q205EH1VU)
    Language English
    Publishing date 2024-01-11
    Publishing country United States
    Document type Clinical Trial, Phase III ; Journal Article ; Randomized Controlled Trial
    ZDB-ID 639099-7
    ISSN 1531-2291 ; 0890-5339
    ISSN (online) 1531-2291
    ISSN 0890-5339
    DOI 10.1097/BOT.0000000000002767
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article: Immune interference revisited: Impact of live-attenuated influenza vaccine prior to yellow fever vaccination

    Blyth, Dana M. / Liang, Zhaodong / Williams, Maya / Murray, Clinton K.

    Vaccine. 2022 Feb. 07, v. 40, no. 6

    2022  

    Abstract: During routine mass live-attenuated influenza vaccination (LAIV) for military personnel, emergent deployment for Ebola humanitarian assistance (OUA) required mass yellow fever vaccination (YF17D), often < 4-weeks recommended timing post-LAIV—triggering ... ...

    Abstract During routine mass live-attenuated influenza vaccination (LAIV) for military personnel, emergent deployment for Ebola humanitarian assistance (OUA) required mass yellow fever vaccination (YF17D), often < 4-weeks recommended timing post-LAIV—triggering concerns for immune interference. We compared YF17D seroconversion rates in personnel who received YF17D as recommended (vaccinated by guidelines [VBG]) to those who received the vaccine outside the recommended timing following LAIV (not vaccinated by guidelines [NVBG]). OUA deploying personnel who received LAIV simultaneously or before YF17D and had pre- and post-vaccination archived serum were included. VBG was defined as YF17D given concurrently or ≥ 30 days post-LAIV and NVBG as YF17D given 1–29 days post-LAIV. YF17D seroresponse was determined by screening ELISA confirmed with plaque reduction neutralization testing (PRNT) on positive ELISA samples. Exclusion criteria were prior YF17D and pre-vaccination YF17D positive PRNT. Of the 660 personnel included, 507 were VBG and 153 were NVBG. Median age was 25 years for both groups. Men accounted for 84% of those VBG and 79% NVBG (p = 0.194). Seroconversion rates were 97.8% for VBG and 95.4% for NVBG (p = 0.15). Multivariate logistic regression revealed that YF17D on days 7–21 post-LAIV (adjusted odds ratio [aOR] 0.304, p = 0.017; confidence interval [CI] 0.114–0.810) and female sex (aOR 0.330, p = 0.026; CI 0.124–0.879) were associated with decreased seroresponse. In this healthy, young adult military population, there was high seroconversion following YF17D when administered simultaneously and at various time points after LAIV. Slight decreases in seroresponse were seen in women and those receiving YF17D 7–21 days following LAIV.
    Keywords blood serum ; confidence interval ; development aid ; females ; human resources ; influenza vaccination ; influenza vaccines ; live vaccines ; military personnel ; neutralization ; odds ratio ; regression analysis ; seroconversion ; yellow fever ; young adults
    Language English
    Dates of publication 2022-0207
    Size p. 961-966.
    Publishing place Elsevier Ltd
    Document type Article
    ZDB-ID 605674-x
    ISSN 1873-2518 ; 0264-410X
    ISSN (online) 1873-2518
    ISSN 0264-410X
    DOI 10.1016/j.vaccine.2021.12.031
    Database NAL-Catalogue (AGRICOLA)

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  10. Article ; Online: Acquisition of Multidrug-Resistant Gram-Negative Organisms During Travel.

    Murray, Clinton K / Blyth, Dana M

    Military medicine

    2017  Volume 182, Issue S2, Page(s) 26–33

    Abstract: The rate of multidrug resistance has continued to increase worldwide, presenting clinicians with further challenges related to patient care. In this article, we review information related to the acquisition of multidrug-resistant (MDR) Gram-negative ... ...

    Abstract The rate of multidrug resistance has continued to increase worldwide, presenting clinicians with further challenges related to patient care. In this article, we review information related to the acquisition of multidrug-resistant (MDR) Gram-negative organisms among travelers, including deployed personnel, as well as the potential impact on wound microbiology and travelers' diarrhea. Travel to Asia, experiencing travelers' diarrhea, and use of antibiotics, whereas abroad have been associated with an increased risk of acquiring MDR Enterobacteriaceae colonization. Acquisition of new pathogens (MDR and non-MDR) through travel may result in microbiome changes (both gastrointestinal and nongastrointestinal), which may lead to alterations in the gastrointestinal flora and antimicrobial resistance. Although the long-term impact of MDR Enterobacteriaceae is unknown, host colonization changes may occur, which could lead to infectious outcomes. In particular, a well-recognized complication is urinary tract infections (UTIs), whereas MDR wound infections, pneumonia, and travelers' diarrhea are also potential outcomes relevant to military health.
    MeSH term(s) Anti-Bacterial Agents/therapeutic use ; Developing Countries/statistics & numerical data ; Drug Resistance, Bacterial ; Escherichia coli/drug effects ; Escherichia coli/pathogenicity ; Escherichia coli Infections/drug therapy ; Gram-Negative Bacteria/drug effects ; Gram-Negative Bacteria/pathogenicity ; Humans ; Travel
    Chemical Substances Anti-Bacterial Agents
    Language English
    Publishing date 2017-09-07
    Publishing country England
    Document type Journal Article
    ZDB-ID 391061-1
    ISSN 1930-613X ; 0026-4075
    ISSN (online) 1930-613X
    ISSN 0026-4075
    DOI 10.7205/MILMED-D-17-00067
    Database MEDical Literature Analysis and Retrieval System OnLINE

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