US Department of Defense
Advancing Blast Injury Research to Protect and Heal Those Who Serve

Epidemiology of Trauma-related Infections among Combat Casualties

The heavy burden of infectious complications following combat-related trauma has been recognized throughout military history. Even in recent conflicts in Iraq and Afghanistan, about one-third of casualties evacuated to US hospitals developed an infection during their initial hospitalization. After discharge, however, the data are more limited so the extent of the burden is not currently well understood.

To address this and other research gaps, the Trauma Infectious Disease Outcomes Study (TIDOS) was designed as a unique DoD-VA collaboration that prospectively collects infection-related data from injured Service members across multiple levels of care, from point of injury to definitive care in the US. Importantly, enrolled patients are followed for a minimum of five years to comprehensively assess the burden of infection.

In Tribble et al. 2018 the TIDOS team now report findings from the initial three years of follow-up of a cohort of 1,014 Service members who sustained combat injuries between June 2009 and May 2012. The report focuses on combat-related open extremity wound infections (CEWI) a common delayed-onset infection, which includes skin and soft-tissue infections (SSTI) and osteomyelitis. Results demonstrate that about 35 percent of patients developed at least one trauma-related infection during their initial hospitalization – 16 percent had one infection, 8 percent had two infections, and 11 percent had three or more infections. Of the patients who initially developed an infection, 45 percent went on to develop a trauma-related infection during the follow-up period. Patients who had three or more infections during their initial hospitalization had a significantly higher rate of infections during the follow-up period compared to those with one infection.

The results of this TIDOS report demonstrate that the burden of trauma-related infections persists years after the initial hospitalization and suggest that additional research on the long-term impacts and outcomes is needed.


Tribble DR, Krauss MR, Murray CK, Warkentien TE, Lloyd BA, Ganesan A, Greenberg L, Xu J, Li P, Carson ML, Bradley W. Epidemiology of Trauma-Related Infections among a Combat Casualty Cohort after Initial Hospitalization: The Trauma Infectious Disease Outcomes Study. Surgical infections, 2018 May 2.DOI: 10.1089/sur.2017.241.

Last modified: 04-Jun-2018