Infection prevention and control in a wartime ICU: a retrospective analysis of 305 combatant cases from a Ukrainian civilian rear hospital.

Authors

Olha Izmailova, Volodymyr Martsiniv, Andrii Strokan, Oksana Piven

Published in

BMC infectious diseases. Jul 11, 2026. Epub Jul 11, 2026.

Abstract

Wartime conditions have exacerbated the importance of infection prevention and control (IPC) practices and their impact on patient prognosis. While microflora contamination occurs at the time of injury, multiple subsequent invasive procedures potentially place patients at a higher risk of acquiring nosocomial flora. This study aimed to evaluate whether the region of trauma, the length of the evacuation chain, or the previous healthcare facility impact the risk of acquiring ESKAPE pathogens upon admission to a rear hospital, and to assess the consequences of these pathogens on wound microflora and patient prognosis.
A retrospective cohort study was conducted at the Feofaniya Clinical Hospital of the State Administration of Affairs, which serves as a rear hospital in Ukraine's medical evacuation chain. Combatants treated in the Surgical Intensive Care Unit (ICU) were selected for analysis. Medical records were reviewed to obtain geographical details of the trauma region, the approximate route and duration of evacuation, injury type, and microbiological results from wound swabs collected upon ICU admission. Binary logistic regression analysis was performed to identify factors associated with the primary outcome.
A total of 264 male combatants admitted between February 2022 and December 2024 were included (mean age: 38.1 years). The median time from injury to admission at the rear hospital was 7 days. The most frequent regions of trauma were Donetsk (57.1%) and Kharkiv (12.2%), with patients primarily evacuated via hospitals in the Dnipro region and the Kharkiv Northern region military medical center. Blast injuries predominated (70.3%), followed by gunshot wounds (22.4%). Initial microbiological screening revealed ESKAPE pathogens in 63.8% of blast injury cases and 62.7% of gunshot wounds. While the prevalence of ESKAPE-positive swabs slightly decreased from 66.0% in 2022 to 58.2% in 2023, it rose to 59.3% in 2024, remaining the dominant finding. Logistic regression analysis indicated that the geographic region of trauma, evacuation route, and duration of evacuation did not significantly affect the risk of ESKAPE pathogen presence upon admission (\(p > 0.05\)). However, the presence of ESKAPE pathogens at admission was a significant independent predictor of mortality (aOR 22.39; 95% CI 2.97-168.55; \(p = 0.003\)).
Our study demonstrated that neither the specific geographical region of injury nor the medical evacuation route significantly influenced the microbiological profile of combat-related wounds upon admission to a rear hospital. ESKAPE pathogens are highly prevalent in the initial wound swabs of combatants and serve as a critical independent predictor of increased in-hospital mortality.
Not applicable.

PMID:
42436438
Bibliographic data and abstract were imported from PubMed on 12 Jul 2026.

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