# P16 Analysis of antibiotic resistance in wounded servicemen with infectious complications

## TL;DR

This study examines antibiotic resistance in wounded soldiers with infections, finding common pathogens and their resistance patterns to guide treatment choices.

## Contribution

The study provides insights into prevalent pathogens and their antibiotic resistance profiles in combat trauma patients with infectious complications.

## Key findings

- Klebsiella pneumoniae and Staphylococcus aureus were the most frequently isolated pathogens.
- K. pneumoniae showed high resistance to multiple antibiotics but remained susceptible to levofloxacin and meropenem.
- S. aureus was resistant to several antibiotics but showed high susceptibility to linezolid.

## Abstract

The problem of antibiotic resistance has now become a global challenge. Infectious complications are the cause of death in 80% of wounded soldiers whose deaths occur late after a military injury. This confirms that the fight against wound infection is one of the priority tasks in the treatment of combat trauma.

To investigate the species composition and susceptibility of microorganisms in servicemen with gunshot wounds and severe infectious complications.

The study analysed 34 case histories of wounded servicemen with infectious complications (sepsis, pneumonia).

Sixty-eight samples of materials were taken, of which 56 samples of biomaterial were isolated from wounds, blood and sputum, and pathogens were isolated. A monoculture was isolated in 85% of cases, in 10% of cases there was a combination of Staphylococcus aureus and Klebsiella pneumoniae, and in 5% of cases different triple combinations of S. aureus with Staphylococcus lentus, Enterobacter, Proteus or Lelliottia amnigena were identified. Most commonly detected were K. pneumoniae (43%) and S. aureus (21%), followed by equal proportions of Enterobacter and Proteus (both 9%), Bacillus spp. (7%) and, in rare cases, L. amnigena, S. epidermidis, S. haemolyticus and S. lentus were isolated (1% each, respectively). Considering that S. aureus and K. pneumoniae were the most frequently isolated pathogens, we analysed their susceptibility. K. pneumoniae was resistant to cefazolin in all cases, and the highest resistance was found to amikacin, amoxicillin, ciprofloxacin, cefepime and piperacillin/tazobactam. The highest levels of susceptibility were found for levofloxacin and meropenem. Susceptibility analysis of S. aureus revealed that this pathogen was not susceptible to azithromycin, amoxicillin, levofloxacin, moxifloxacin, ofloxacin, piperacillin/tazobactam or cefazolin. Linezolid had the highest susceptibility of 90%.

The choice of antibiotic therapy for wounded soldiers should take into account the possibility of infection with highly virulent pathogens that can cause secondary purulent complications. In addition, it should be noted that due to the phasing of care from the battlefield to tertiary care, the risk of developing resistance increases as pathogens constantly migrate and change their susceptibility to antibiotics.