Features of the Microbial Landscape and Antibacterial Chemotherapy in Mine-Blast Wounds in Modern Military Conflicts

Background. Modern military conflicts are characterized by an increase in the incidence of mine-blast wounds (MBWs). Bacterial infection may lead to severe purulent complications. The microbial landscape and antibiotic susceptibility of bacteria in MBWs are poorly understood and remain a subject of debate. The aim of this study was to analyze the species composition and antibiotic resistance of bacteria in patients with lower extremity MBWs. Material and methods. The results of examination and treatment of 575 patients with lower extremity MBWs were retrospectively analyzed. The median age of the wounded was 35 years [IQR: 18–60], and the median time since the injury was 16 days [IQR: 4–62]. Microbiological examination included qualitative analysis of bacterial flora and determination of antibiotic susceptibility. Wound discharge and tissues obtained during surgical debridement (SD) were examined. Antibiotic susceptibility testing was performed using the disk diffusion method. Results. Co-infection was predominant and amounted to 70.1% of the cases. Among gram-positive microorganisms, Enterococcus faecalis was most common at 43.9%. Among gram-negative bacteria, the most common were: Acinetobacter spp. — 39.3%, Pseudomonas aeruginosa — 19.9%, Klebsiella pneumoniae — 18.9%, Escherichia coli — 12.2%, Enterobacter spp. — 11.4%. The longer the time since the injury, the more frequently gram-negative microorganisms were isolated. The highest polyantibiotic resistance was noted among Acinetobacter spp. (69.6%), K. pneumoniae (66.5%) and P. aeruginosa (40.1%). The need for repeated chemical wound ablation was observed more often when Acinetobacter spp. and P. aeruginosa were isolated (69.8% and 42.5%). Conclusion. MBWs are characterized by high levels of microbial associations and gram-negative flora, the number of which increased over time after the wound formation. This demonstrates the importance of controlling wound contamination with hospital-acquired, polyantibiotic-resistant microflora.

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