Microbiological Characteristic of Infectious Complications of War Wounds in Various Armed Conflicts

During any armed conflicts the question of managing the gunshot wounds with infection complications is particularly acute. The extremities wounds account for 65% on the average. During World War II they constituted 58%, in Korea and Vietnam Wars they were 60.2% and 61.1% respectively, during the period 2001-2005 in Iraq and Afghanistan their number was 54.5%. Infectious complications are diagnosed in 33% of cases involving the wounds, and in 26.8% these complications are caused by bacteria with multiple resistances to antibiotics. During the treatment, the share of infectious complications increases from 35% to 45% with prevalence of soft tissue infections and osteomyelitis. The wounds of extremities prevailed in the period of 2014-2016 in the conflict in the East of Ukraine and accounted for 57.1%. The bacteriology of war wounds constantly undergoes changes. So, within a century it changed from Clostridia species, which were the main cause for infections during World War I, to Streptococci and Staphylococcus aureus during World War II, and to the gram negative rods (Pseudomonas aeruginosa, Enterobacter species, E. coli, and Klebsiella spp.) during Korea and Vietnam Wars. The emergence of new methods of surgical treatment (which led to the victory over the infections caused by Clostridia spp.) and the invention of antiseptics and antibiotics (inspiring reduction of infectious complications caused by gram-positive cocci) became the cornerstone of these changes. In the last conflicts in Iraq and Afghanistan the wound infection developed in several days after injury, and in most cases was caused by gram-negative microorganisms, including Pseudomonas aeruginosa, E. coli and Klebsiella spp., with the prevalence of Acinetobacter baumannii. The main feature of these isolates is multiple resistances to antibiotics. Conclusions. According to bacteriological analyses of war wounds of the previous conflicts, there are certain regularities inherent in each separate military conflict. An important factor is availability of the timely surgery. In prospect, it is expected that the new wave of causative microorganisms will inevitably consist of resistant nosocomial strains. The problem of microbiological monitoring of infectious complications is particularly acute for Ukraine as for the state, which is involved into the armed conflict. The obscure questions for the conflict in Ukraine are biological properties peculiar for microorganisms, which cause an infection, and criteria for choice, administration or change of antibiotics.