[Pathogen Spectrum of Complex Wounds in Germany from War Zones]

Background Treatment of the injured from war zones with wounds with multi-resistant pathogens is becoming more common in Germany, especially in German Armed Forces Hospitals. In most cases, the pre-treatment of these patients has been inadequate and they have a high load of rare pathogens. In Germany, hospitals have to evaluate these pathogens by law. The aim of this study was to review current German guidelines and data on the array of pathogens of complex trauma wounds in Germany and to compare patients with wounds and multi-resistant pathogens from war zones treated in Germany. Patients and Methods A PubMed search was performed on all multiresistant pathogens, antibiotic resistance and guidelines in Germany from 2005 to 2015. The databases and recommendations of the Robert Koch Institute, the Paul Ehrlich Society and the National Reference Centre for the Surveillance of Nosocomial Infections were analysed. The screening results of injured patients from war zones treated in the German Armed Forces Hospital Ulm were included. Results The array of pathogens for nosocomial infections has not changed, but the ratios of the pathogens has altered. Methicilin-resistant Staphylococcus aureus (MRSA) has decreased, but vancomycin-resistant enterococci have increased continuously. Enterococcus faecium (E. faecium) now make up the largest fraction of VRE. The databases do not yet provide data on the relatively new classification of multiresistant gramnegative (MRGN) pathogens. MRGN pathogens play the main role in injured patients from war zones. Conclusion In the last ten years, there have been changes in the resistance and ratios of multi-resistant pathogens. MRSA has decreased over the last ten years, but reserve antibiotics are increasingly needed. VRE are increasing and even some reserve antibiotics have lost their efficacy because of the use of modern antibiotics. There are not yet any German datasets available on 3- and 4-MRGN. These pathogens play the main role in injured patients from war zones treated in Germany: it is crucial to perform routine screening and to take all precautions, including isolation. Surgical wound therapy is of increasing importance and uncritical and expensive antibiotic therapy is becoming becomes less important.