Pathogens Present in Acute Mangled Extremities From Afghanistan and Subsequent Pathogen Recovery

Abstract

Given the changing epidemiology of infecting pathogens in combat casualties, we evaluated bacteria and fungi in acute traumatic wounds from Afghanistan. From January 2013 to February 2014, 14 mangled lower extremities from 10 explosive-device injured casualties were swabbed for culture at Role 3 facilities. Bacteria were recovered from all patients on the date of injury. Pathogens recovered during routine patient care were recorded. The median injury severity score was 29, median initial Role 3/4 blood product support was 32 units, and median evacuation time was 42 minutes to first surgical care. Gram-positive bacteria were found in some wounds but not methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus. Most wounds were colonized with low-virulence, environmental gram-negative bacteria, and not recovered again during therapy, reflecting wound contamination. Only one wound had the same bacteria (E. cloacae) throughout care at the Role 3, 4, and 5 facilities. Three cultures from two patients had multidrug-resistant bacteria (E. cloacae, E. coli), all detected at Role 5 facilities. Molds were not detected at Role 3, whereas one patient had a mold at Role 4 and 5. Mangled lower extremity injuries have a high contamination rate with environmental organisms, which are not typically associated with infections during the course of the patient's care.

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

“…The fact of shifting in wound microbiology in the favor of bacteria responsible for healthcare-associated infections such like S. aureus , Enterococcus spp., Enterobacteriaceae , P. aeruginosa and Acinetobacter spp. support to the proposition that these changes are nosocomially related [4, 14]. For Ukrainian military medicine, this study is the first time-specified assessment of battle wound colonization from the World War II.…”

“…Despite the differences in wound management and antibiotic strategies between Ukrainian and US medical system similarity in microbiological characteristics of battle-wounds looks like a global challenge. That fact that those shifts in wound microbiology developed during patient’s stay in the same medical facility lend further support to the proposition that these changes are nosocomially related [4, 14]. Similar data about microbiological specter of battle-wound which we receive from different parts of the Globe, made us think wider about this problem.…”

“…This information can help to treat battle wound infections or even changes infection control strategies. The fact of shifting in wound microbiology in the favor of bacteria responsible for healthcare-associated infections support to the proposition that these changes are nosocomially related [4, 14]. For Ukrainian military medicine this study is the first time-specified assessment of battle wound colonization from the World War II.…”

Lessons of war

“…Similar to the findings in Vietnam the initial colonizing gram-negative isolates were typically low-virulence environmental organisms. (21, 51) Of concern was the finding that 2 of 4 S. aureus isolates were methicillin-resistant (MRSA). Importantly, positive wound cultures were noted in 5 of 8 wounds with only antimicrobial administration prior to admission, compared to 0 of 6 wounds with field irrigation only, and 1 of 6 with both field irrigation and antimicrobial administration.…”

Examination of the Kinetics of Antimicrobial Substance Release from Polymer Compounds by Using Microbiological Method in Conjunction with Mathematical Analysis

“…Зокрема міс-цеве використання поліметилметакрілатних (ПММА) композицій насичених антибіотиками пок-ращує результати лікування відкритих переломів [1]. Антимікробні речовини, що використовують в системах локальної доставки, які ще недавно ефе-ктивно впливали на збудників ранової інфекції, швидко втрачають свою ефективність, завдяки розповсюдженню полірезистентних мікроорганізмів [2]. Зростання кількості інфекційних ускладнень та важкість їх лікування підштовхує до розробки нових композицій з протимікробними властивостями.…”