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

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ABSTRACT

Background: Microbiology of modern war wounds is unique for each military conflict. Climatic and geographical features of the theater of war, contemporary warfare as well as wound management affect the microbial flora of wounds. This study was designed to determine time-specific microbial flora of combat wounds of upper and lower extremities obtained during the war in eastern Ukraine.

Methods: The patients enrolled in study had combat wounds of upper or lower extremities which were treated in the Military Medical Clinical Center of Central Region. The wounds were swab-cultured and measured at each surgical debridement. The recovered microorganisms were identified and their antimicrobial resistance profiles were evaluated by disc diffusion method.

Results: Forty-nine patients with battle-field wounds were enrolled in the study from July to November 2014; all patients were male with a mean Injury Severity Score and arrival APACHE II scores of 16.2 ± 10.7 and 7.4 ± 4.2 respectively. Among 128 swab cultures, 100 swab cultures were positive. Swab cultures were obtained from 57 wounds of 49 patients. The results of the test showed that 87.7% of all positive swab cultures contained a single-organism while the rest of the swab-culture results showed polymicrobial growth. Among the isolated microorganisms 65% (76 strains) were Gram-negative rods, 22.2% (26 strains) of Gram-positive cocci, followed by Gram-positive rods (12.8%, 15 strains). We found that epidemiology of wound infection changes with the time after injury. The most common bacterial isolates cultured during the first week were Gram-positive microbes with low pathogenicity. The number of Gram-negative rods increased during the wound healing process. The incidence of Gram-positive microorganisms’ growth fell after the first week and increased after third week. During wound healing, bacterial microflora of wounds changes with increasing number of Gram-negative rods with predominance of Acinetobacter species. Predominant microorganisms in positive swab-cultures after first week were nonfermentative Gram-negative bacilli (68% of swab-cultures), which in 53% of the swab-cultures belonged to the genus Acinetobacter, and in 15% to the genus Pseudomonas. The incidence of polymicrobial wound cultures increased from first week to second post-injury week. The most frequent microbial mixture were Acinetobacter baumannii with Enterobacteriaceae or other nonfermentative Gram negative rods with Enterococcus spp. We observed bacteria recovery from wounds during proliferation phase. These wounds had no pure inflammation signs and were free of devitalized tissues.

Conclusions: Any wound is at some risk of becoming infected. In the event of infection, a wound fails to heal, treatment costs rise, and general wound management practices become more resource demanding. Determining the microorganisms which colonize battle wounds and cause wound infection is paramount. 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.

Electronic supplementary material: The online version of this article (doi:10.1186/s13104-017-2481-4) contains supplementary material, which is available to authorized users.

No MeSH data available.


Related in: MedlinePlus

A proportion of microorganisms along wound healing on a week basis. A graph demonstrates the difference in wound microbial community composition from week to week over a 5-week period
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Fig1: A proportion of microorganisms along wound healing on a week basis. A graph demonstrates the difference in wound microbial community composition from week to week over a 5-week period

Mentions: Fifty-seven wounds were studied and included in the analysis. Forty-one wounds (71.9%) were in the lower extremities and 16 in the upper extremities (28.1%). The mean surface area of the wounds was 95.6 cm2 [standard deviation (SD) ±123.7 cm2, range 5.1–452 cm2]. The mean wound volume was 456.2 cm3 (SD ±853 cm3, range 11.5–3740.8 cm3). One hundred twenty-eight swab cultures were performed on the 57 wounds. The mean number of swab culture per wound was 2.5 (SD ±0.8). Of the 128 swap cultures, 28 cultures (21.8%) showed no growth and 100 (78.1%) were positive for bacterial growth (Fig. 1).Fig. 1


Bacterial flora of combat wounds from eastern Ukraine and time-specified changes of bacterial recovery during treatment in Ukrainian military hospital
A proportion of microorganisms along wound healing on a week basis. A graph demonstrates the difference in wound microbial community composition from week to week over a 5-week period
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC5384141&req=5

Fig1: A proportion of microorganisms along wound healing on a week basis. A graph demonstrates the difference in wound microbial community composition from week to week over a 5-week period
Mentions: Fifty-seven wounds were studied and included in the analysis. Forty-one wounds (71.9%) were in the lower extremities and 16 in the upper extremities (28.1%). The mean surface area of the wounds was 95.6 cm2 [standard deviation (SD) ±123.7 cm2, range 5.1–452 cm2]. The mean wound volume was 456.2 cm3 (SD ±853 cm3, range 11.5–3740.8 cm3). One hundred twenty-eight swab cultures were performed on the 57 wounds. The mean number of swab culture per wound was 2.5 (SD ±0.8). Of the 128 swap cultures, 28 cultures (21.8%) showed no growth and 100 (78.1%) were positive for bacterial growth (Fig. 1).Fig. 1

View Article: PubMed Central - PubMed

ABSTRACT

Background: Microbiology of modern war wounds is unique for each military conflict. Climatic and geographical features of the theater of war, contemporary warfare as well as wound management affect the microbial flora of wounds. This study was designed to determine time-specific microbial flora of combat wounds of upper and lower extremities obtained during the war in eastern Ukraine.

Methods: The patients enrolled in study had combat wounds of upper or lower extremities which were treated in the Military Medical Clinical Center of Central Region. The wounds were swab-cultured and measured at each surgical debridement. The recovered microorganisms were identified and their antimicrobial resistance profiles were evaluated by disc diffusion method.

Results: Forty-nine patients with battle-field wounds were enrolled in the study from July to November 2014; all patients were male with a mean Injury Severity Score and arrival APACHE II scores of 16.2 ± 10.7 and 7.4 ± 4.2 respectively. Among 128 swab cultures, 100 swab cultures were positive. Swab cultures were obtained from 57 wounds of 49 patients. The results of the test showed that 87.7% of all positive swab cultures contained a single-organism while the rest of the swab-culture results showed polymicrobial growth. Among the isolated microorganisms 65% (76 strains) were Gram-negative rods, 22.2% (26 strains) of Gram-positive cocci, followed by Gram-positive rods (12.8%, 15 strains). We found that epidemiology of wound infection changes with the time after injury. The most common bacterial isolates cultured during the first week were Gram-positive microbes with low pathogenicity. The number of Gram-negative rods increased during the wound healing process. The incidence of Gram-positive microorganisms’ growth fell after the first week and increased after third week. During wound healing, bacterial microflora of wounds changes with increasing number of Gram-negative rods with predominance of Acinetobacter species. Predominant microorganisms in positive swab-cultures after first week were nonfermentative Gram-negative bacilli (68% of swab-cultures), which in 53% of the swab-cultures belonged to the genus Acinetobacter, and in 15% to the genus Pseudomonas. The incidence of polymicrobial wound cultures increased from first week to second post-injury week. The most frequent microbial mixture were Acinetobacter baumannii with Enterobacteriaceae or other nonfermentative Gram negative rods with Enterococcus spp. We observed bacteria recovery from wounds during proliferation phase. These wounds had no pure inflammation signs and were free of devitalized tissues.

Conclusions: Any wound is at some risk of becoming infected. In the event of infection, a wound fails to heal, treatment costs rise, and general wound management practices become more resource demanding. Determining the microorganisms which colonize battle wounds and cause wound infection is paramount. 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.

Electronic supplementary material: The online version of this article (doi:10.1186/s13104-017-2481-4) contains supplementary material, which is available to authorized users.

No MeSH data available.


Related in: MedlinePlus