Background: Armed conflicts are a major contributor to injury and death globally. Conflict-related injuries are associated with a high risk of wound infection, but it is unknown to what extent infection directly relates to sustainment of life and restoration of function. The aim of this study was to investigate the outcome and resource consumption among civilians receiving acute surgical treatment due to conflict-related injuries. Patients with and without wound infections were compared.
Methods: We performed a cohort study using routinely collected data from 457 consecutive Syrian civilians that received surgical treatment for acute conflict-related injuries during 2014-2016 at a Jordanian hospital supported by Médecins Sans Frontières. We defined wound infection as clinical signs of infection verified by a positive culture. We used logistic regression models to evaluate infection-related differences in outcome and resource consumption.
Results: Wound infection was verified in 49/457 (11%) patients. Multidrug-resistance (MDR) was detected in 36/49 (73%) of patients with infection. Among patients with infection, 11/49 (22%) were amputated, compared to 37/408 (9%) without infection, crude relative risk = 2.62 (95% confidence interval 1.42-4.81). Infected patients needed 12 surgeries on average, compared to five in non-infected patients (p < .00001). Mean length of stay was 77 days for patients with infection, and 35 days for patients without infection (p = .000001).
Conclusions: Among Syrian civilians, infected conflict-related wounds had a high prevalence of MDR bacteria. Wound infection was associated with poor outcomes and high resource consumption. These results could guide the development of antibiotic protocols and adaptations of surgical management to improve care for wound infections in conflict-related injuries.
Trial Registration: ClinicalTrials.gov ( NCT02744144 ). Registered April 13, 2016. Retrospectively registered.
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Article Synopsis
- - The year 2022 saw a significant rise in global state-based armed conflicts, totaling 56, with major violence in Ukraine, Myanmar, and Nigeria causing over 10,000 deaths, followed by a notable conflict between Israel and Hamas in October 2023.
- - These escalating conflicts are now at their highest level since 1946, threatening global health through physical injuries, increased infectious diseases, malnutrition, and serious mental health issues, making it harder to achieve Sustainable Development Goals by 2030.
- - The paper calls for urgent strategies to address the health crisis in conflict zones, including humanitarian responses, the protection of healthcare facilities and workers, and enhancing mental health support and preparedness.
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