LIANE HANSEN, host:
From NPR News, this is WEEKEND EDITION. I'm Liane Hansen.
(Soundbite of thumping)
HANSEN: Marine Sergeant David Emery is rolling his wheelchair down a ramp outside his home.
Mr. DAVID EMERY (Marine Sergeant): All the things you can do in a wheelchair. You can jump curbs if there's not a ramp or whatever to get up on the curb.
HANSEN: Twenty-two-year-old Emery lives in Julianne, Pennsylvania. His one-year-old daughter Carly sits on his lap. In February 2007, Emery was working at a checkpoint near Haditha, Iraq, when he was seriously injured by a suicide bomber.
Mr. EMERY: We were standing at this checkpoint with some higher ups. They wanted to see how it was operating and stuff so we took them down. And we were getting ready to leave and there was a large explosion. At first I thought it was mortars, but there was only one explosion, so then I figured that wasn't it. And then I was, like, trying to just, like, get up and find my rifle and stuff but I couldn't move. And I couldn't see anything either.
I remember a couple of my friends coming over and talking to me and stuff. And my lone buddy, I remember him giving me some water and then they put me in the back of a Humvee, then they pulled me out of the Humvee and put me back in a helicopter.
HANSEN: Emery lost both his legs. Not only as a result of the attack but also because of a drug-resistant bacteria that infected him afterwards. Military doctors know it by its official name - Acinetobacter baumannii. The troops call it Iraqibacter.
Mr. EMERY: Come on in.
Dr. GLENN WORTMANN (Physician, Walter Reed Army Medical Center): Oh, come in here.
Mr. EMERY: It's all right.
Dr. WORTMANN: (Unintelligible) let you in.
Mr. EMERY: Okay. Thanks, Worty.
HANSEN: This is the infectious disease ward at Walter Reed Army Medical Center in Washington, D.C.
Dr. WORTMANN: So, this is our clinic. We have four to five physicians and we have approximately eight or nine trainees that are working with us at any one time.
HANSEN: Colonel Glenn Wortmann is a physician who heads up the infectious disease unit at Walter Reed.
Dr. WORTMANN: We see a variety of things, from Lyme Disease to post-traumatic wound infections.
HANSEN: Wortmann says that Acinetobacter baumannii wasn't even on the radar before the Iraq War. Military doctors at Walter Reed saw just one or two cases in a year. But soon after the Iraq War began, strange and harmful infections began to turn up on the USS Comfort, a naval hospital ship stationed in the Persian Gulf.
Dr. WORTMANN: I think the thing that's unique about this bacteria is how quickly it's become resistant to multiple antibiotics. In 2000, 1999, the few Acinetobacter we had were fairly susceptible to antibiotics. Whereas now Acinetobacter baumannii has evolved to where we're seeing bacteria, which are resistant to most, if not all, antibiotics.
HANSEN: Wortmann says combat hospitals can be an ideal environment for bacteria to evolve and become resistant to drugs. But it's unclear how this particular bacteria became so dangerous.
Dr. WORTMANN: We don't know for sure, we don't know for sure. Some of the hospitals in Iraq, some of the fixed facility ones, had been used previously as hospitals by the Iraqis. We moved into those facilities. Those bacteria were probably there when we came into the facilities.
There's movement of people among the combats in poor hospital, so it may have gone from that facility to another facility. We really don't know how it initially got started.
Mr. CHAS HENRY (Retired Marine Corps Captain): Five years hence now, 15 to 20 percent of wounded soldiers and Marines coming back from Iraq and Afghanistan are still either infected with Acinetobacter baumannii or have it on their skin. It raises real questions of whether more should have been done.
HANSEN: Chas Henry is a retired Marine Corps captain. He reported on the so-called Iraqibacter phenomenon for Proceedings, a monthly magazine published by the United States Naval Institute in Annapolis, Maryland. Henry found that seven deaths have been linked to this bacteria. But it's not just the troops from Iraq and Afghanistan who have been affected - infants and elderly patients in military health centers have also been infected with Acinetobacter.
But the majority of those who get this disease are wounded troops. Again, Chas Henry.
Mr. HENRY: Because Acinetobacter baumannii is so highly resistant to many of the commonly used antibiotics now, doctors had to go back and pull highly toxic antibiotics off the shelf. Antibiotics that have a significant chance of causing kidney damage or nerve damage. So, you were talking about, say, a 20-year-old who had been saved by very aggressive quick surgery at a frontline hospital and doctors are having to say is this person infected? It'll take me 72 hours to do the test to find out if he is. And I don't treat him right away, we could have to cut off another limb. If he isn't and I treat him with this highly toxic antibiotic, I could be putting this kid on dialysis for the rest of his life.
HANSEN: Marine Sergeant David Emery lived through months of pain and agony as he fought this infection. He's finally back home with his baby daughter Carly. His mother, Connie, is helping to care for her injured son. We caught up with her last week.
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HANSEN: Tell us when you first noticed that your son David had this infection? I mean, what did you see? What did the doctors tell you?
Ms. CONNIE EMERY (Mother of David Emery): Well, it's one of those things where they tell me that there is nothing that can control it. They give him antibiotics but they that your antibodies, your own antibodies are the ones that have to fight it. He, at one point, three of his major organs were shut down.
HANSEN: Because of the infection?
Ms. EMERY: Yeah, his liver was the only one he wasn't having trouble with. And then they actually found a spot on it and they wanted to take a biopsy of it but the one trauma surgeon said no, 'cause he was a bleeder as a it was and he was in and out of the ER every other day. So they just scraped it and thank God, you know, healed itself over and he was fine then.
HANSEN: Infectious disease experts say what is lacking is coordination across all branches of the military to contain the spread of drug-resistant bacteria like Acinetobacter.
Dr. TIMOTHY ENDY (Retired Army Colonel, Former Division Director of Communicable Disease and Immunology, Walter Reed Institute of Research): Trying to communicate what we were experiencing in the Army to the other services was very difficult because there was no uniform policy and no uniform surveillance program that everyone could share. None.
HANSEN: Dr. Tim Endy is a retired Army colonel. Until 2006 he was division director of communicable disease and immunology at the Walter Reed Institute of Research. Endy says the military medical system has done a lot to save troops injured in Iraq, but it needs to do more.
Dr. ENDY: There really needs to be a surveillance program for possible spread bacteria that goes across all services, and which should include the Veteran's Administration as well. The other frustration is the implementation of policy within the theater. This bacteria can really rapidly adapt to any kind of pressure from antibiotics.
So that, you know, we were starting to see a very high rare resistance to some of the most powerful antibiotics that we had. And as we found out in theater they started to use these antibiotics as first line drugs. And the bacteria very rapidly adapted to become resistance. So, there needs to be a method of trying to develop policy that starts from the Surgeon General that can be executed within the theater very rapidly.
HANSEN: Colonel Duane Hospenthal is a physician who advises the Army Surgeon General on infectious diseases. He says the military does screen for Acinetobacter baumannii and other multi-drug-resistant bacteria, though the information is not centrally reported or analyzed.
Dr. DUANE HOSPENTHAL (Colonel, Physician): I agree with Colonel Retired Endy. It has been difficult to establish uniform screening and surveillance practices. Because of the multi-drug-resistant bacterial problem, which includes Acinetobacter baumannii, we did get together a large group of civilian and military experts in trauma, and it was suggested that a team go into the theater and review for invention and practices.
And this review was conducted in February and March of 2008. And a report of potential intervention that could decrease colonization of infection will subsequently be coming forward.
Unidentified Woman: I got your message, sir.
Unidentified Man: Okay. Great.
Unidentified Woman: I've been running into a few meetings as you are today too...
HANSEN: Walter Reed Army Medical Center sees about 200 patients every year, who are colonized by Acinetobacter baumannii. That means they have the bacteria on their skin but they have not necessarily become infected. Colonel Wortman, who heads up the infectious disease unit, says the biggest problem is the lack of effective drugs to fight this bacteria.
Dr. WORTMAN: It's not a military problem, it's a global problem. We're out of antibiotics. The market forces, which drive the development of new drugs, tend to favor drugs that people take forever, like diabetes treatment, HIV treatment, high cholesterol. Antibiotics, we tell people don't use, it's not a moneymaker. But there needs to be something done to encourage pharmaceutical companies to make new antibiotics.
HANSEN: Back at the home of wounded Marine Sergeant David Emery, he and his mother Connie get Carly ready for a nap. It's been a rough year for Emery. DJ, as he's known, had both his legs amputated, he's now going through a divorce. But after months in intensive care, the Acinetobacter infection is finally gone.
How do you feel now?
Mr. EMERY: Oh, I feel great now.
HANSEN: Do you?
Mr. EMERY: Yeah.
HANSEN: Now, your daughter, who we've been listening to in the room, what's your routine with her? What do you do with her on a daily basis?
Mr. EMERY: Usually we get up, I'll get her something for breakfast and usually she takes a nap shortly after that. We might go for a ride on the wheelchair outside, the electric wheelchair.
HANSEN: Does she like that?
Mr. EMERY: Oh, it's hard getting her off it when we're done riding.
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Mr. EMERY: I'm trying to get her to walk.
HANSEN: Are you?
Mr. EMERY: Passing her back and forth on the floor.
HANSEN: No kidding.
Mr. EMERY: Yeah.
HANSEN: Can I talk to your mom again?
Mr. EMERY: Yeah, here she is.
HANSEN: Thank you.
Ms. EMERY: Hello?
HANSEN: Hi there, Connie. How are you coping? I mean, you're taking care of your son, you're taking care of your granddaughter, and you've had to go through a lot.
Ms. EMERY: Yeah, I did. But I look at this way: I said one day, you know, it's hard, you know. You didn't want to try to show no emotion in front of him because, you know, he was trying to pull the fight of his life. But I had my time too where, you know, you have a breakdown and wonder why. You know, good kid, never did anything to anybody and, you know, why does he have to go through this.
HANSEN: He sounds like someone that's not going to let his limitations limit him.
Ms. EMERY: He was never one to sit around and he's not one to have somebody feel sorry for him. So, him and Carly will have a good life.
HANSEN: It sounds like David and Carly are going to start learning how to walk at the same time.
Ms. EMERY: Yeah. Oh, he said he's going to walk before her and then he had this setback here in February. But he's back at it again now, so it's going to run a close race on that one.
HANSEN: In his own effort to walk again, Emery is trying out five different prosthetic legs. His upper body maintains the athletic build of a fireball left-handed pitcher, which he was before he entered the Marines. Later this season he hopes to coach pitchers for the Belfont Foibles, a local youth baseball team.
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HANSEN: Our story was produced by David Shulman and Davar Iran Ardalan and edited by Jenny Berkoff.
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