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

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.