Evaluation of infectious complications in pediatric patients with armed conflict-related injuries referred to a tertiary hospital in Turkey.

Abstract

Conflict-related injuries in pediatric populations are associated with significant infectious complications, particularly due to delayed medical care and invasive procedures. This study aimed to evaluate infection characteristics, causative microorganisms, antimicrobial resistance, and treatment approaches in children hospitalized with conflict-related injuries. This retrospective, single-center study included pediatric patients (1 month-18 years) hospitalized between November 2023 and June 2024 with armed conflict-related injuries and confirmed bacterial and/or fungal cultures. Demographic, clinical, and microbiological data were analyzed. Among 592 hospitalized pediatric patients, 39 (6.6%) had positive cultures, yielding 90 microbial isolates. Gram-negative bacteria predominated (71%), with Pseudomonas aeruginosa (40%), Klebsiella pneumoniae (10%), Acinetobacter baumannii (10%), and Escherichia coli (10%) being most common. P. aeruginosa was primarily isolated from wound sites (77.7%) and was significantly associated with internal fixators (p = 0.003). Multidrug resistance (MDR) was identified in 72.2% of P. aeruginosa isolates, and carbapenem resistance was notable in A. baumannii (77.8%) and K. pneumoniae (55.5%). Fungal isolates accounted for 13.3% of cultures, predominantly Candida albicans from urine samples. No fungal growth was observed in wound cultures. Median time from injury to positive culture was 59 days, shorter for P. aeruginosa (p = 0.039). No mortality occurred.

Conclusions: Pediatric patients with armed conflict-related injuries exhibit high rates of infection with MDR gram-negative bacteria, notably P. aeruginosa. The findings underscore the importance of early intervention, infection control, and tailored antimicrobial therapy. Future multicenter prospective studies with advanced microbiological techniques are warranted to optimize management and outcomes.

What is known: • Infectious complications are common in armed conflict-related injuries, especially in delayed admissions. Gram-negative bacteria and multidrug resistance are frequently observed in conflict-related wounds.

What is new: • This study highlights high rates of multidrug-resistant Pseudomonas aeruginosa in pediatric armed conflict-related injuries. Early culture-guided treatment and infection control are critical for better outcomes.