SENSITIVITY OF WOUND INFECTION PATHOGENS TO ANTIBACTERIAL DRUGS AFTER MINE-BLAST TRAUMA IN MILITARY PERSONNEL: RESULTS OF A RETROSPECTIVE COHORT STUDY
DOI:
https://doi.org/10.32782/2411-9164.21.2-6Keywords:
mine-explosive injury, combat injury, wound infection, sensitivity to antibioticsAbstract
Introduction. Combat injuries are associated with a significant prevalence of infectious complications, reaching up to 48.2% of patients depending on the location and injury severity [1]. High levels of pathogen resistance to antibacterial agents is common for wound infection [2–4]. Therefore, our aim was to determine the sensitivity of wound infection pathogens to antibacterial agents in military personnel with combat trauma. Materials and methods. We conducted a retrospective single-center cohort study of patients with blast injuries who had infectious complications (wound infection and/or bacteremia) or suspicion for them. The study was conducted at L4-L5 hospital and covered the period from February 24, 2022, to March 14, 2024. Demographic, clinical and laboratory data of the patient cohort were collected. Cultures and sensitivity analysis of isolates were performed according to standard operating procedures of the institution and relevant guidelines. Statistical analysis was performed using MS Excel and R 4.4.1 software. Results. Among the patients included in the study (n=448), 1169 wound cultures were performed and 1531 bacterial isolates were obtained. The cumulative resistance to antibiotics in the access, observation and reserve groups were 71%, 78.4% and 54.4% of all tests performed, respectively. Low levels of resistance were observed only to vancomycin (5.1%), colistin (11%) and tigecycline (17.3%). Among the most common pathogens, K.pneumoniae had low levels of resistance to colistin (13.8%) and tigecycline (13.5%), A.baumannii – to cefoperazone/sulbactam (16.5%), colistin (0.9%) and tigecycline (12.3%), and P.aeruginosa – to colistin (7%). The cumulative resistance of less common isolates ranged from 29.6% to 62.6%. Discussion and conclusions. The resistance of wound infection pathogens is extremely high and exceeds the data described in the literature for other conflicts and civilian patients. Choice of antibiotics is limited to reserve drugs. Patients with wound infection require targeted antibiotic therapy as soon as possible, taking into account current data on antibiotic susceptibility.
References
Petfield J.L., Lewandowski L.R., Stewart L., Murray C.K., Tribble D.R. IDCRP Combat-Related Extremity Wound Infection Research. Mil Med. 2022 May 5;187(Suppl 2):25–33.
Peretz A., Labay K., Zonis Z., Glikman D. Disengagement does not apply to bacteria: a high carriage rate of antibiotic-resistant pathogens among Syrian civilians treated in Israeli hospitals. Clin Infect Dis Off Publ Infect Dis Soc Am. 2014 Sep 1;59(5):753–4.
Al-Assil B., Mahfoud M., Hamzeh A.R. Resistance trends and risk factors of extended spectrum β-lactamases in Escherichia coli infections in Aleppo, Syria. Am J Infect Control. 2013 Jul;41(7):597–600.
Krishtafor D.A., Krishtafor A.A., Halushchak A.Y., Mynka V.Y., Seleznova U.V., Grabova G.Y. Antibacterial therapy for combat gunshot trauma: eight years after (retrospective observational study). Emerg Med. 2023 Sep 11;19(4):241–8.
Granata G., Petersen E., Capone A., Donati D., Andriolo B., Gross M., et al. The impact of armed conflict on the development and global spread of antibiotic resistance: a systematic review. Clin Microbiol Infect. 2024 Jul 1;30(7):858–65.
European Centre for Disease Prevention and Control. Operational public health considerations for prevention and control of infectious diseases in the context of Russia’s aggression towards Ukraine. Stockholm: ECDC; 2023. URL: https://www.ecdc.europa.eu/en/publications-data/operational-public-health-considerations-prevention-and-control-infectious.
Tribble D.R., Krauss M.R., Murray C.K., Warkentien T.E., Lloyd B.A., Ganesan A., Greenberg L., Xu J., Li P., Carson M.L., Bradley W., Weintrob A.C. Epidemiology of Trauma-Related Infections among a Combat Casualty Cohort after Initial Hospitalization: The Trauma Infectious Disease Outcomes Study. Surg Infect (Larchmt). 2018 Jul;19(5):494–503. doi: 10.1089/sur.2017.241. Epub 2018 May 2. PMID: 29717911; PMCID: PMC6025694.
Mende K., Stewart L., Shaikh F., Bradley W., Lu D., Krauss M.R., Greenberg L., Yu Q., Blyth D.M., Whitman T.J., Petfield J.L., Tribble D.R. Microbiology of combat-related extremity wounds: Trauma Infectious Disease Outcomes Study. Diagn Microbiol Infect Dis. 2019 Jun;94(2):173–179. doi: 10.1016/j.diagmicrobio.2018.12.008. Epub 2018 Dec 29. PMID: 30691724; PMCID: PMC6520157.
Sahli Z.T., Bizri A.R., Abu-Sittah G.S. Microbiology and risk factors associated with war-related wound infections in the Middle East. Epidemiol Infect. 2016 Oct;144(13):2848–57.
Кришевський Ю.П., Горошко В.Р., Хитрий Г.П. Мікробіологічна структура та чутливість патогенної флори до антибіотиків у пацієнтів із пораненнями черевної порожнини. Медицина Невідкладних Станів. 2020;(16, № 1):72–7.
Желіба М.Д., Верба А.В., Богуш Г.Л., Марцинковський І.П., Кондратюк В.М., Ковальчук В.П. та ін. Мікробіологічні аспекти ранової інфекції у потерпілих внаслідок бойових дій та її комплексне лікування з застосуванням вакуум-терапії. 2019 [cited 2024 Oct 15]. URL: https://dspace.vnmu.edu.ua/handle/123456789/6165.
Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action – PMC [Internet]. [cited 2024 Oct 24]. URL: https://pmc.ncbi.nlm.nih.gov/articles/PMC10580644/.
Міністерство охорони здоров’я України. Наказ МОЗ України від 23.08.2023 № 1513 про затвердження стандарту медичної допомоги: раціональне застосування антибактеріальних і антифугальних препаратів з лікувальною та профілактичною метою [Інтернет]. Київ : Міністерство охорони здоров’я України. 2023. URL: https://moz.gov.ua/uk/decrees/nakaz-moz-ukraini-vid-23082023--1513-pro-zatverdzhennja-standartu-medichnoidopomogi-racionalne-zastosuvannja-antibakterialnih-i-antifungalnih-preparativ-zlikuvalnoju-ta-profilaktichnoju-metoju.
Yaacoub S., Truppa C., Pedersen T.I., Abdo H., Rossi R. Antibiotic resistance among bacteria isolated from war-wounded patients at the Weapon Traumatology Training Center of the International Committee of the Red Cross from 2016 to 2019: a secondary analysis of WHONET surveillance data. BMC Infect Dis. 2022 Mar 14;22:257.
Puca V., Marulli R.Z., Grande R., Vitale I., Niro A., Molinaro G., Prezioso S., Muraro R., Di Giovanni P. Microbial Species Isolated from Infected Wounds and Antimicrobial Resistance Analysis: Data Emerging from a Three-Years Retrospective Study. Antibiotics (Basel). 2021 Sep 24;10(10):1162. doi: 10.3390/antibiotics10101162. PMID: 34680743; PMCID: PMC8532735.
