Multidrug-resistant bacterial infections of the libyan civil war victims: what did we learn?

Objective: Complicated by nosocomial infections and wide spectrum antibiotherapy, combat related injuries (CRI) are associated with resistant gram-negative microorganisms, especially at the later stage. The aim of this study is to retrospectively investigate demographic, clinical and microbiologic characteristics of 45 CRI patients transferred from Libya and hospitalized in a private clinic. Material and Method: Surveillance cultures (nasal, rectal, wound swabs, trakeal aspirates, urine and blood cultures) were obtained and isolated bacteria and their antibiotic susceptibility were identified using VITEK (R) 2 system (bioMerieux, Marcy l'Etoile, France). Results: The median age of 45 patients (44 [97.8%] male) was 30.7 +/- 12.9 years. The majority of the injuries were due to firearms (66.7%) and 22 (48.9%) patients were injured on the lower extremities. Open bone fractures were present in 30 (66.6%) patients. Primary wound site infection was present in 28 (62.2%) patients. Surveillance cultures revealed 40 microorganisms from the samples of 29 patients, which were gram-negative rods in 22 (55%), gram-positive cocci in 17 (42.5%) and fungus in 1 (2.5%) patients). Of the 40 isolated microorganisms, 13 (32.5%) were non-resistant, 10 (22.2%) were MDR, and 13 (28.9%) were XDR. None of the patients died in the study period. Conclusion: Despite the limited number of cases, this study presents the characteristics of the Libyan combat victims treated by a multidisciplinary team at a single center. Surveillance cultures revealed many victims to be infected or colonised by MDR/XDR bacteria. Early surgical wound debridement, early initiation of antibiotic therapy in the proper dose and spectrum, and obtaining wound site cultures whenever necessary may help to provide more favorable outcomes in CRI victims.