Monitoring of the dynamics of antimicrobial resistance among wounded in the conditions of armed conflict

Abstract

Introduction. The article presents the results of monitoring antibiotic resistance of microorganisms isolated from military personnel undergoing long-term treatment in specialized hospitals. A high level of resistance to antibacterial drugs was established. The predominance of gram-negative microflora was noted not only in the general structure of the development of purulent-inflammatory processes, but also in resistance. Of particular concern are isolates that have proven to be resistant to the reserve group of drugs.

Purpose. Monitoring the sensitivity of microorganisms to antibacterial drugs in patients with various types of injuries caused by military events.

Materials and methods. Bacteriological examination of biological material using Vitek-2 Biomerieux automated pathogen systems and classic, followed by determination of sensitivity using the disk-diffusion method.

Results. Mine-explosive injuries of a severe degree and bullet wounds are the main ones in the structure of combat casualties among the hospitalized. Antibiotics and antimicrobials play a crucial role in reducing morbidity and mortality, and not only among humans. The danger is caused by injured persons with penetrating wounds and persons with surgical intervention, open multifragmentary fractures, endoprosthetics, metal implants and burns. During the bacteriological examination, 439 types of microorganisms were isolated, 38.4% of which were MRSA, vancomycin-resistant enterococci, colistin-resistant and carbopenem-resistant gram-negative rods. Also, 24.0% were isolated MDR strains (resistant to two or more groups of antibiotics). There was a quantitative predominance of Gr(-) flora over Gr(+). Today, antibiotic resistance is increasing to significant levels throughout the world. In addition to the mechanisms already familiar to us, new ones are being formed that contribute to the development of unpredictable situations during treatment. Timely started treatment makes it possible to control the course of the infectious process and increases the chances of the patient’s recovery. In this case, the time factor plays a key role.

Conclusions. During the analysis of antibiotic resistance of microorganisms, an increase in the level of resistance of almost all groups of isolates was found. The levels and spectra of antibiotic resistance in relation to widely used antibacterial drugs were determined. Comparative results of bacteriological examinations of patients for 2022 and 2023. allow us to draw a conclusion about the high level of circulation of polyresistant clinical isolates. In monitoring patients, in 2023, drugs of the reserve group were used 1.8 times more often than in the period of 2022. which indicates a growing resistance to the main medicines. The obtained data make it possible to detect the formation of hospital strains in a timely manner, to carry out epidemiological analysis and effective management. Thanks to the joint work of the military and civilian health care systems, 70% of military personnel are able to return to the ranks of defenders.