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Publications

Journal Article Ahead of print

PubMed: 42720539 DOI: 10.1093/milmed/usag420

Anatomical Site-Specific Microbiological Divergence in Combat-Related Injuries During the Ukraine Conflict: A Comparative Analysis of Head, Torso, and Extremity Wounds.

Mil Med

Authors: Oleksandra Pryshchepa, Ewelina Sibińska, Viktoriia Avramenko, Oleksandr Bespalko, Yegor Babenko, Svitlana Yaremchuk, Michał Złoch, Polina Vakuliuk, Paweł Pomastowski

Affiliations

  • Centre for Modern Interdisciplinary Technologies, Institute of Advanced Studies, Nicolaus Copernicus University in Torun, Torun, Poland.
  • Faculty of Natural Sciences, Department of Chemistry, National University of Kyiv-Mohyla Academy, Kyiv, Ukraine.
  • Department of Otorhinolaryngology, Pediatric Otorhinolaryngology, and Audiology, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine.
  • Department of Family Medicine, Shupyk National Healthcare University of Ukraine, Kyiv, Ukraine.

Abstract

INTRODUCTION

Combat-related infection research is overwhelmingly skewed toward extremity injuries because of the effectiveness of modern body armor. This creates a critical knowledge gap regarding the microbiological dynamics of non-limb anatomical sites, particularly in the context of intense warfare. This study evaluates the wound microflora of 51 Ukrainian soldiers during the second phase of the conflict with Russia, focusing on head and torso injuries. A key objective was to investigate how blast-induced acoustic barotrauma-including tympanic membrane perforation and mucosal damage-acts as a potential modifier of local microbiota composition in the ear, nose, and oropharyngeal regions.

MATERIALS AND METHODS

Superficial swabs (58 total) were collected from torso, extremity, and ENT (ear, nose, oropharynx) wounds of 51 military patients undergoing prolonged hospitalization at the Kolomiychenko Institute of Otolaryngology in Kyiv. Microorganisms were isolated using selective media and identified via MALDI-TOF mass spectrometry. Identification was confirmed by 16S rRNA gene sequencing. The study received institutional approval from the NaUKMA Research Ethics Committee on June 9, 2025 (Protocol No. 8).

RESULTS

The analysis distinguished 209 isolates at the species level, covering 74 species and 36 genera. Gram-positive bacteria were the largest (71%) and most diverse group. Although extremity infections aligned with the established paradigm of Gram-negative dominance (63%), ENT wounds showed a dramatic Gram-positive prevalence (74%-97%), with Staphylococcus species representing 71% of aural isolates. Torso wounds exhibited an even distribution of Gram types (50/50), characterized by an unusually high frequency of Enterococcus (38.5%). ESKAPE pathogens accounted for 24% of all identified microorganisms, with S. aureus being most pronounced in the head area.

CONCLUSIONS

These findings demonstrate that blast-induced barotrauma is not only a mechanical injury but a significant modifier of local microbiological environments. The study's strength lies in providing a comprehensive comparison of head, torso, and limb wounds, revealing that site-specific physiological conditions fundamentally alter colonizing microbiota. A primary challenge identified is the risk of diagnostic masking, where abundant commensal flora may obscure aggressive pathogens. Consequently, implementing site-specific diagnostic protocols and susceptibility testing is essential to optimize targeted antimicrobial therapy and improve the clinical prognosis for wounded soldiers.

MeSH

Genes, Genes, Rrna, Conflict, Psychological, Barotrauma, Military Medicine, Nose, Wounds And Injuries, Microbiota, Infections