ArticleEuropean journal of trauma and emergency surgery : official publication of the European Trauma Society2026
War injuries and antimicrobial resistance: what impact do multi-resistant pathogens have on the treatment of Ukrainian war- wounded patients?
Article in European journal of trauma and emergency surgery : official publication of the European Trauma Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeWar injuries are characterized by a high incidence of bone and soft tissue infections caused by multidrug-resistant (MDR) pathogens. We analyzed the influence of infections with MDR pathogens on the course and outcome of 17 Ukranian patients within the first three years of surgical therapy.
methodsTo assess the clinical course of Ukrainian war-wounded patients treated in our tertiary care hospital between June 2022 and May 2025, the characteristics of hospital stay, number of operations, bacterial spectrum of wound infections and antibiotic therapies were analyzed retrospectively.
resultsPatients had sustained mostly severe extremity injuries several months (105.3 ± 25.1 days) prior to admission. The average length of hospital stay was 165.6 ± 29.6 days. An average of 13 ± 3 operations were performed per patient during this time. Secondary limb amputation was required in 3/17 patients (18%). MDR bacteria were detected in 11/17 cases (65%). The most common pathogen (in 9/17 patients (53%)) was carbapenem-resistant Klebsiella pneumoniae. The most frequently detected carbapenemase was New Delhi metallo-beta-lactamase. Due to multiple resistance, antibiotic therapy with ‘last-resort’ antibiotics such as aztreonam/avibactam or cefiderocol was initiated in 12/17 cases (71%).
conclusionMDR pathogens and high rates of carbapenem resistance are commonly detected in war-injured patients. Traumatized patients should be given special importance in an interdisciplinary treatment concept, given the long hospital stays in a foreign country, MDR pathogens, and imminent amputation of a limb. A successful treatment frequently requires the individualized use of novel antibiotics in combination with radical surgical debridement. LEVEL OF EVIDENCE: III, Retrospective/Cohort analysis
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