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Background The current war in Ukraine is associated with frequent applications of multiple-launch rocket systems and cruise missiles as well as other various high-energy weapons to cause severe injuries in military personnel including abdomen wounds, vascular injury, and limb amputations as well as genitourinary trauma. The aim of this report is to demonstrate a case of successful penile salvage by restoring its function in a combat patient with gunshot genitourinary trauma in conditions of an interrupted supply of medical equipment. Case presentation We describe a case of a 48-year-old male patient with a combined shrapnel gunshot wound to the penis with damage to the urethra and combined injury to the soft tissues of the left thigh. Several hours after the injury, the patient underwent primary surgical debridement of the left thigh, ligation of the great saphenous vein of the thigh, primary sutures on the penile urethra and navicular fossa, suturing of the rupture of the head and penis, drainage of the wound, catheterization of the bladder, and epicystostomy. An artificial erection was performed intraoperatively. The urethral catheter was removed 3 weeks after urethral suturing (May 4, 2022). The epicystostomy was removed 5 months after the injury (August 4, 2022) and 2 days after the restoration of spontaneous urination. At the follow-up of 7 months after the injury, the patient has normal urination with minor urinary dribbling, sufficient erection, and ejaculation. Conclusions We have shown that in a case of gunshot wounds to the penis and hanging part of the urethra, even in the presence of combined severe purulent lesions of non-urological localizations, it is possible to perform a primary reconstruction of urogenital injuries using a primary urethral suture and applying a negative pressure device. Findings from this case report shed new light on the management of penile gunshot injury in ongoing warfare as well as provide evidence of the possibility to perform adequate management for penile injury in conditions of limited medical resources, violation of international humanitarian law, and under frequent strikes of high-energy weapons.

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Annotation. The aim of the study was to identify the predominant microorganisms that caused health care associated infections in the intensive care unit (for surgical patients) National Military Medical Center “Main Military Clinical Hospital” in 2018. Identification of microorganisms was carried out in the laboratory department (microbiological), clinic of laboratory diagnostics the same hospital, which has national accreditation for work with microorganisms of the III – IV class of pathogenicity. The results of 631 bacteriological examinations were analyzed, namely 240 samples of blood from 88 patients, 269 urine samples from 77 patients, 97 samples of endotracheal content/sputum, obtained from 16 patients and another 25 samples from other anatomical sites (the bile ductus drains, pleural fluids) from 8 patients. Statistical processing was performed using Microsoft Excel 2016. The significance of the difference was checked by the method of χ2. The number of samples without growth was 206 (33 %). There were founded that the leading microorganism was K. pneumoniae 105 (25 %) isolates, followed by P. aeruginosa with 80 isolates (19 %), P. mirabilis 19 (4 %), E. coli 18 (4 %). The fraction of gram-positive bacteria was 31 % (118 isolates). There is a prominent difference among predominant microorganisms that caused health care associated infections corresponding to the anatomic site infection (p˂0.05). In blood cultures the K. pneumoniae (26 %) were leading microorganism, while P. aeruginosa (24 %) was found predominant in the respiratory tract, and Enterococcus spp (23 %) were the main isolates from the urine. Any isolates of A. baumannii were cultured. Formalizing the process of bacteriological observation, careful selection of patients for research and collection of epidemiological information featuring health care associated infections in the intensive care unit will systematize the process of infection control and allow to apply a quality control system.