Antibacterial therapy for combat gunshot trauma: eight years after (retrospective observational study)

Abstract

Background. Combat gunshot wounds are characterized by massive tissue destruction and significant contamination. Infectious complications are the cause of death of 80 % victims who died late after a combat injury. Therefore, the fight against wound infection is one of the priority tasks in the treatment of combat trauma. The purpose of our study was to determine the changes in the composition of the bacterial microflora of combat gunshot wounds and its sensitivity to antibacterial drugs between 2014 and 2022. Materials and methods. We examined 167 patients with gunshot combat injuries, of which 29 were admitted in 2014, and 138 in 2022. Based on the results of bacteriological examinations of wounds performed upon admission to a third-level hospital, we studied the frequency of wounds colonization, its nature (contamination/infection), the nature of the identified microflora and its sensitivity to antibacterial drugs. Results. Of the bacteriological studies performed in 2014, no growth was found in 27.6 % of cases, in 2022 — in 41.3 % (p = 0.168). Among the positive results in 2014, 30.8 % of pathogens met the criteria for infection (≥ 104 colony-forming units; in 2022, 63.8 % (p < 0.001). In 2014, A.baumannii (21.4 %), S.haemolyticus (19.0 %), gut bacteria (19.0 %) and P.aeruginosa (11.9 %) prevailed among pathogens. In 2022, the Bacillus spp. (28.4 %), A.baumannii (19.6 %), gut bacteria (14.2 %) and K.pneumoniae (10.1 %) were detected most frequently. At the same time, in 71.1 % of cases, the number of Bacillus spp. bacteria met the criteria for infection.