Evidence map›Paper›PMID 40875607›Full record

ArticleMilitary medicine2026

Early Factors Related to Healthcare Utilization by Infection Status among Combat Injured.

Laveta Stewart, Faraz Shaikh, Erica Sercy, M Leigh Carson, Daniel Gedeon, Andrew C Wyatt, Wesley R Campbell, Katrin Mende, John L Kiley, Patrick Richard and 1 more

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In one paragraph

Article in Military medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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0citing papers in PubMed
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1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Laveta StewartInfectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States.
Faraz ShaikhInfectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States.
Erica SercyInfectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States.ORCID 0000-0002-7975-8601
M Leigh CarsonInfectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States.
Daniel GedeonDepartment of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, MD 20814, United States.
Andrew C WyattLandstuhl Regional Medical Center, Landstuhl 19180, Germany.
Wesley R CampbellInfectious Disease Service, Walter Reed National Military Medical Center, Bethesda, MD 20889, United States.
Katrin MendeInfectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States.
John L KileyInfectious Disease Service, Brooke Army Medical Center, Fort Sam Houston, TX 78234, United States.ORCID 0000-0003-1726-1699
Patrick RichardDepartment of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, MD 20814, United States.
David R TribbleInfectious Disease Clinical Research Program, Preventive Medicine and Biostatistics Department, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, United States.

Funding

Defense Health Program HU0001190002Department of Preventive Medicine and BiostatisticsDepartment of the Navy HU0001-10-1-0014Disease Clinical Research ProgramHealth Services Research ProgramInfectious Disease Clinical Research ProgramNational Institute of Allergy and Infectious DiseasesNIAID NIH HHS Y01 AI005072NIH HHSNIH HHS Y1-AI-5072The Henry M. Jackson FoundationThe Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc.Uniformed Services University of the Health Sciences
6 · The paper itself

Abstract

introductionCombat casualty care is resource-intensive; however, the impact of battlefield-related infections on healthcare utilization is not fully understood. We assessed factors associated with hospitalization among wounded military personnel by infection outcome. MATERIALS AND

methodsThe study population for this cross-sectional retrospective analysis included military personnel wounded during deployment (June 1, 2009-December 31, 2014), admitted to Landstuhl Regional Medical Center (Germany), and transferred to participating military hospitals in the continental United States. Patients consented to the review of electronic medical records through the Military Health System (MHS) Data Repository. Patients were classified as having a trauma-related infection with a multidrug-resistant Gram-negative bacillus, infection attributed to other pathogens, or without infection during initial hospitalization. Hospital healthcare utilization within the first 2 weeks post-injury among patients with infections was assessed to identify factors associated with longer hospitalization.

resultsThe study population consisted of 1,018 patients; 148 patients with a multidrug-resistant Gram-negative bacilli infection, 320 with an infection attributed to another pathogen, and 550 without infections. Hospital length of stay was a median of 59.5 days for patients with multidrug-resistant Gram-negative bacilli infections compared to 42 days for infections with other pathogens and 22 days for patients without infections (P < .001). Critical care (e.g., intensive care unit admission/duration, mechanical ventilation, and procedures), and collection of clinical cultures were more frequent among patients with multidrug-resistant Gram-negative bacilli infections compared with those with other pathogens and without infections (P < .05) and are plausible factors to potentially explain why their longer hospitalization. Patients with multidrug-resistant Gram-negative bacilli infections received more aminoglycosides, aminopenicillin, antipseudomonal penicillin, antiparasitics, antifungals, carbapenems, macrolides, polymyxins, trimethoprim-sulfamethoxazole, and vancomycin than patients with infections attributed to other pathogens (P < .05), with an overall greater duration of antimicrobial use (median: 51 vs. 38 days; P < .001). When adjusted for injury severity, clinical microbiology workups, surgeries, and other factors shown to be associated with hospitalization in the multivariate model, having an infection with a multidrug-resistant Gram--negative bacillus was associated with a stay of 5 extra days for every 30 days stayed by a patient with infections attributed to other pathogens.

conclusionsCombat casualty care is associated with high resource utilization and the occurrence of multidrug-resistant Gram-negative bacilli infections significantly adds to the healthcare burden on the MHS. Examination of incremental changes in healthcare costs associated with battlefield-related infections is warranted to inform the allocation of needed resources to treat these patients.

Indexed as

Military PersonnelPatient Acceptance of Health CareAdultCross-Sectional StudiesFemaleHospitalizationHumansLength of StayMaleRetrospective StudiesUnited StatesWounds and Injuries

Identifiers

PMID40875607
PMCPMC13016836

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.