Bacterial flora of combat wounds from eastern Ukraine and time-specified changes of bacterial recovery during treatment in Ukrainian military hospital

Abstract

BackgroundMicrobiology of modern war wounds is unique for each military conflict. Climatic and geographical features of the theater of war, contemporary warfare as well as wound management affect the microbial flora of wounds. This study was designed to determine time-specific microbial flora of combat wounds of upper and lower extremities obtained during the war in eastern Ukraine.MethodsThe patients enrolled in study had combat wounds of upper or lower extremities which were treated in the Military Medical Clinical Center of Central Region. The wounds were swab-cultured and measured at each surgical debridement. The recovered microorganisms were identified and their antimicrobial resistance profiles were evaluated by disc diffusion method.ResultsForty-nine patients with battle-field wounds were enrolled in the study from July to November 2014; all patients were male with a mean Injury Severity Score and arrival APACHE II scores of 16.2 ± 10.7 and 7.4 ± 4.2 respectively. Among 128 swab cultures, 100 swab cultures were positive. Swab cultures were obtained from 57 wounds of 49 patients. The results of the test showed that 87.7% of all positive swab cultures contained a single-organism while the rest of the swab-culture results showed polymicrobial growth. Among the isolated microorganisms 65% (76 strains) were Gram-negative rods, 22.2% (26 strains) of Gram-positive cocci, followed by Gram-positive rods (12.8%, 15 strains). We found that epidemiology of wound infection changes with the time after injury. The most common bacterial isolates cultured during the first week were Gram-positive microbes with low pathogenicity. The number of Gram-negative rods increased during the wound healing process. The incidence of Gram-positive microorganisms’ growth fell after the first week and increased after third week. During wound healing, bacterial microflora of wounds changes with increasing number of Gram-negative rods with predominance of Acinetobacter species. Predominant microorganisms in positive swab-cultures after first week were nonfermentative Gram-negative bacilli (68% of swab-cultures), which in 53% of the swab-cultures belonged to the genus Acinetobacter, and in 15% to the genus Pseudomonas. The incidence of polymicrobial wound cultures increased from first week to second post-injury week. The most frequent microbial mixture were Acinetobacter baumannii with Enterobacteriaceae or other nonfermentative Gram negative rods with Enterococcus spp. We observed bacteria recovery from wounds during proliferation phase. These wounds had no pure inflammation signs and were free of devitalized tissues.ConclusionsAny wound is at some risk of becoming infected. In the event of infection, a wound fails to heal, treatment costs rise, and general wound management practices become more resource demanding. Determining the microorganisms which colonize battle wounds and cause wound infection is paramount. This information can help to treat battle wound infections or even changes infection control strategies. The fact of shifting in...

Antimicrobial resistance profile among bacteria isolated from patients presenting with wounds at Kabale Regional Referral Hospital, South western Uganda

“…The majority of wound isolates were gram negative bacilli (61%) which is in agreement with Hauke et al from Ghana, Mekonnen et al from Ethiopia, and Valentine et al from Ukrainian military hospital who reported Gram negative bacteria as the predominating pathogens in wound infections [17,18,19] . Escherichia coli, Klebsiella spp., Proteus sp.…”

“…were other common gram negative bacteria observed in our study. In a recent report from Ukraine, Gram negative bacteria, particularly Enterobacteriaceae, were found as major pathogens [19] . However, the presence of gram positive bacteria (39%) in the current study is supported by several literatures [20,7,15] .…”

Molecular Epidemiology of Carbapenem-Resistant Acinetobacter baumannii Isolated from War-Injured Patients from the Eastern Ukraine

“…Acinetobacter spp. were particularly abundant as part of the wound flora in war-injuries in later stages of the wound consolidation process, while Gram-positive bacteria dominated at the beginning [27]. Carbapenem-resistance in A. baumannii bloodstream isolates from Ukrainian hospitals is high, with a prevalence of 63.2% reported in a multi-center study of Ukrainian hospitals between 2013 and 2015 [28].…”

“…From the Eastern Ukrainian conflict, infections of war-injured patients with multi-drug resistant Acinetobacter spp. have been described [27]; however, a detailed investigation into the species distribution is lacking. Acinetobacter spp.…”

Cascading Risks for Preventable Infectious Diseases in Children and Adolescents during the 2022 Invasion of Ukraine

“…Wounds can become easily infected, mainly by community acquired microorganisms, such as Staphylococcus epidermidis and Bacillus spp., pathogens that predominate in the first week of an injury [ 31 ]. Despite the relatively low virulence of these bacteria, their treatment in children can be very challenging, especially during wartime, which has further diminished access to antibiotics and limited the supply of wound care kits.…”