Document Type

Capstone Experience

Graduation Date


Degree Name

Master of Public Health



First Committee Member

Sharon J. Medcalf, PhD - University of Nebraska Medical Center

Second Committee Member

Abraham D. Mengist, PhD, Msc. - University of Nebraska Medical Center

Third Committee Member

Makoto M. Jones, MD, Msc. - University of Utah / Veterans Health Administration


Multidrug-resistant organisms (MDRO) pose a great threat to health across the globe. That threat is also felt in the Veterans Health Administration (VHA). Wounded warriors returning home from the battlefields of Iraq and Afghanistan may have brought with them MDROs, such as the bacterium Acinetobacter baumannii, as they have transitioned from military service into the VHA facilities. This study investigates the interconnectedness of military service in the Department of Defense (DoD) and a lifetime of care at VHA through a longitudinal tracking of a linked cohort of combat veterans with battlefield injuries and subsequent MDR infections of A. baumannii. This study has sought to understand the spread of this MDRO beyond returned combat veterans as a potential reservoir to others throughout the nationwide VA healthcare system. This study will highlight the downstream implications of emerging MDROs brought back home from future foreign wars and campaigns that U.S. Armed Forces become engaged in. Furthermore, it will underscore the need for modernization of the current MDRO identification and surveillance capabilities of VHA to adopt more utility of available molecular techniques. With appropriate pathogen identification and surveillance, this knowledge can have a significant impact on infection prevention and control programs, antibiotic stewardship plans, and drug formularies that are used both locally and nationwide.