Infectious complications of mine-explosive trauma: etiology of wound infections and principles of antimicrobial therapy (literature review)

Infectious complications remain the leading cause of mortality and prolonged hospitalisation in military personnel sustaining mine-explosive trauma (MET). The aim of this study was to analyse the current spectrum of infectious complications of MET, evaluate the aetiological structure of wound pathogens, and determine rational principles of antimicrobial prophylaxis and therapy. A systematic review of 18 scientific publications from 2012–2025 was performed. Infectious complications were found to develop in 27–35 % of combat casualties and in 52 % of those sustaining traumatic amputations. In contemporary conflicts, the dominant pathogens are multidrug-resistant Gram-negative bacteria– Acinetobacter baumannii, Klebsiellapneumoniae, and Pseudomonas aeruginosa – with carbapenem resistance rates reaching 73–90 %. The cornerstone of antimicrobial prophylaxis remains prompt cefazolin administration per TCCC protocol; radical wound debridement is essential for infection prevention. The spread of multidrug-resistant organisms from conflict zones constitutes a global epidemiological threat.

1. Привольнев, В. В., Агафонов, О. И., Андреев, И. М. Антибиотикопрофилактика инфекционных осложнений в военно-полевой хирургии // Клиническая микробиология и антимикробная химиотерапия. – 2012. – Т. 14, № 3. – С. 191–200.

2. Privolnev, V. V., Agafonov, O. I., Andreev, I. M. Antibiotic prophylaxis of infectious complications in military field surgery // Klinicheskaya mikrobiologiya i antimikrobnaya khimioterapiya. 2012;14(3):191–200. [In Russian].

3. Пильников, С. А., Войновский, А. Е., Брижань, Л. К., Путинцев, С. П. Гнойные осложнения ампутаций нижних конечностей при минно-взрывной травме // Вестник Национального медико-хирургического центра им. Н. И. Пирогова. – 2020. – Т. 15, № 1. – С. 62–67. https://doi.org/10.25881/BPNMSC.2020.15.11.012

4. Pilnikov, S. A., Voinovsky, A. E., Brizhan, L. K., Putintsev, S. P. Purulent complications of lower limb amputations in mine-explosive trauma // Vestnik Natsionalnogo mediko-khirurgicheskogo tsentra im. N. I. Pirogova. 2020;15(1):62–67. https://doi.org/10.25881/BPNMSC.2020.15.11.012 [In Russian].

5. Beley, N., Loskutov, O., Strokan, A., Izmaylova, O. Evolution of the microbiota of wound infections in military personnel during the full-scale Russian invasion: a retrospective cohort study (2022–2024) // Emergency Medicine. – 2024. – Vol. 20, № 7. – P. 615–621. https://doi.org/10.22141/2224-0586.20.7.2024.1767

6. Coccolini, F., Sartelli, M., Sawyer, R. et al. Antibiotic prophylaxis in trauma: Global Alliance for Infection in Surgery, Surgical Infection Society Europe, World Surgical Infection Society, American Association for the Surgery of Trauma, and World Society of Emergency Surgery guidelines //Journal of Trauma and Acute Care Surgery. – 2024. – Vol. 96, № 4. – P. 674–682. https://doi.org/10.1097/TA.0000000000004233

7. Holubnycha, V., Kholodylo, K. War impact on antimicrobial resistance and bacteriological profile of wound infections in Ukraine // Communications Medicine (Nature). – 2025. https://doi.org/10.1038/s43856-025-01056-6

8. Invasive Fungal Infection in War Wounds. Joint Trauma System Clinical Practice Guideline. – 17 Jul 2023. – ID28. https://jts.health.mil/assets/docs/cpgs/Invasive_Fungal_Infection_in_War_Wounds_17_Jul_2023_ID28.pdf

9. Karp, M. C., April, M. D., Newberry ,R. K., Schauer, S. G. Associations with Prehospital Antibiotic Receipt among Combat Casualties with Open Wounds: A Department of Defense Trauma Registry Study // Military Medicine. – 2024. – Vol. 189, № 3–4. – P. e606–e611. https://doi.org/10.1093/milmed/usad323

10. Kondratiuk, V., Jones, B. T., Kovalchuk, V. et al. Phenotypic and genotypic characterization of antibiotic resistance in military hospital-associated bacteria from war injuries in the eastern Ukraine conflict between 2014 and 2020 // Journal of Hospital Infection. – 2021. – Vol. 112. – P. 69–76. https://doi.org/10.1016/j.jhin.2021.03.020

11. Ljungquist, O., Nazarchuk, O., Kahlmeter, G. et al. Highly multidrug-resistant Gram-negative bacterial infections in war victims in Ukraine, 2022 // Lancet Infectious Diseases. – 2023. – Vol. 23, № 7. – P. 784–786. https://doi.org/10.1016/S1473-3099(23)00291-8

12. Lloyd, B. A., Murray, C. K., Shaikh, F. et al. Antimicrobial Prophylaxis with Combat-Related Open Soft-Tissue Injuries // Military Medicine. – 2018. – Vol. 183, № 9–10. – P. e260–e265. https://doi.org/10.1093/milmed/usx125

13. Mc Gann, P. T., Lebreton, F., Jones, B. T. et al. Six Extensively Drug-Resistant Bacteria in an Injured Soldier, Ukraine // Emerging Infectious Diseases. – 2023. – Vol. 29, № 8. – P. 1692–1695. https://doi.org/10.3201/eid2908.230567

14. McDonald, J. R., Liang, S. Y., Li, P. et al. Infectious Complications After Deployment Trauma: Following Wounded US Military Personnel Into Veterans Affairs Care // Clinical Infectious Diseases. – 2018. – Vol. 67, № 8. – P. 1205–1212. https://doi.org/10.1093/cid/ciy280

15. Pallett, S. J. C., Trompeter, A., Basarab, M., Moore L. S. P., Boyd, S. E. Multidrug-resistant infections in war victims in Ukraine // Lancet Infectious Diseases. – 2023. – Vol. 23, № 8. – P. e270–e271. https://doi.org/10.1016/S1473-3099(23)00391-2

16. Petfield, J. L., Lewandowski, L. R., Stewart, L., Murray C. K., Tribble D. R. IDCRP Combat-Related Extremity Wound Infection Research // Military Medicine. – 2022. – Vol. 187, Suppl. 2. – P. 25–33. https://doi.org/10.1093/milmed/usab065

17. GBD 2021 Antimicrobial Resistance Collaborators. Global burden of bacterial antimicrobial resistance 1990– 2021: a systematic analysis with forecasts to 2050 // Lancet. – 2024. – Vol. 404, № 10459. – P. 1199–1226. https://doi.org/10.1016/S0140-6736(24)01867-1

18. Stevenson, C. Evolving mechanisms and patterns of blast injury and the challenges for military first responders // Journal of Military and Veterans Health. – 2023. – Vol. 17, № 4. https://doi-ds.org/doilink/11.202183158248/JMVH Vol 17 No 4

19. Stewart, L., Shaikh, F., Bradley, W. et al. Combat-Related Extremity Wounds: Injury Factors Predicting Early Onset Infections // Military Medicine. – 2019. – Vol. 184, Suppl. 1. – P. 83–91. https://doi.org/10.1093/milmed/usy336

20. Aro, T., Häkkinen, T. A., Holmberg, V., Kajova, M., Kantele, A. War on antimicrobial resistance: high carriage rates of multidrug-resistant bacteria among war-injured Ukrainian refugees / Clinical Microbiology and Infection. – 2025. – Vol. 31, № 11. – P. 1923–1925. https://doi.org/10.1016/j.cmi.2025.07.010