Infection in Wounds of Conflict – Old Lessons and New Challenges

Abstract

Infection is an important consideration in war wounds. Improvements in survival and use of increasingly broad-spectrum antibiotics have led to new challenges with novel pathogens and conventional pathogens with multiple drug resistance patterns.. learnt in conflicts centuries ago. The cornerstone remains early, appropriate and repeated surgery. Antimicrobial agents contribute a very minor part to overall patient outcome, but prudent use of antibiotics and good infection control is essential to prevent establishment and spread of hospital-acquired infections. Research in progress will provide an evidence base for antibiotic and infection control policies and baseline data for research into novel wound management strategies.

Antimicrobial assays of three native British plants used in Anglo-Saxon medicine for wound healing formulations in 10th century England

“…The initial literature search revealed three major herbal texts with the Old English Herbarium selected as the most appropriate for starting the selection criteria in that it comprises mainly single formulations of plants having multiple applications for different conditions associated with wounds and bacterial infections. Battle wounds and burns were commonplace in Anglo-Saxon England (van Arsdall, 2002) and mortality rates were high with sword, sling shot and arrow injuries as well as individuals being exposed to potential infections from bloody wounds (Hutley and Green, 2009). In the phytochemical and pharmacological search a number of the Napralert SM reports showed the selected plants to have negative antimicrobial assay results that may be interpreted as the plants being inactive; alternatively it may be harsh extraction methods degrading the active compounds of the original formulation resulting in little or no antimicrobial activity.…”

Infection in conflict wounded

“…This notion of selecting therapy to target agents posing the greatest threat to those recently injured is similarly championed by Hutley and Green [68].…”

“…Such models need to encompass injury not just by bullets and metallic fragments but also by blast to reflect current combat wounding. Inoculation with all the various species of bacteria associated with point of wounding [58] would be possible as well as more unusual organisms such as fungi recently reported in some severe wound infections of casualties from Afghanistan [68]. Until such time that more up to date, military specific evidence is available, standard practice with narrow spectrum agents only for delayed evacuation remains best practice.…”

“…In the presence of a healthy healing wound, this does not imply MRSA infection, but merely the presence of the organism. Systemic antibiotic treatment would not be indicated in such a case and could indeed be detrimental [68].…”

“…Scarce resources are typically directed at patient survival as opposed detailed microbiological study, which has minimal impact on immediate patient care. Methodologically sound, ethically approved assessment of skin and wound colonization from point of first surgical intervention for both deployed combatants and host-nation patients is required and studies are in development using the unique military environment and medical support to Allied operations in Afghanistan [68]. Such research will provide clinicians with a detailed microbiological picture of inoculation, colonization and subsequent infection of wounds in that geographical area.…”