Infectious complications of war-related injuries in children: Experience from the Gaza Conflict

Conflict related trauma frequently results in high energy blast injuries complicated by infection with multidrug resistant (MDR) organisms. This study aimed to describe the injury patterns, microbiology, antimicrobial resistance profiles, and clinical outcomes among children with war related injuries from Gaza treated at a tertiary orthopedic reconstructive center.

We conducted a retrospective observational cohort study of children aged 0-18 years referred between November 2023 and November 2024. Demographic, injury, microbiological, antimicrobial, surgical, and outcome data were collected. Infections were confirmed by infectious diseases and microbiology review.

Forty nine children were included (median age 11 years; range 1-17). Blast injuries accounted for 44/49 (89.8%) cases, 42/49 (85.7%) had open fractures, 18/49 (36.7%) had polytrauma, and 15/49 (30.6%) had amputations. Sixteen children (32.7%) had active infection, including chronic osteomyelitis (COM) in 18.4%. Infection was polymicrobial in 15/16 (93.8%). Multidrug resistant organisms were identified in 75% of infections. Pseudomonas aeruginosa was isolated in 12/16 cases (75%), Enterobacterales in 11/16 (68.8%), and Staphylococcus aureus in 8/16 (50%), of which 7 were methicillin resistant. Carbapenem resistant Enterobacterales colonization was detected in 7/20 (35%) screened children. Children with COM had significantly longer hospital stays (median 57 days) and a higher surgical burden compared with non infected patients.

War-related pediatric trauma from Gaza was characterized by severe blast injury, requiring specialist ortho-plastic care with frequent polymicrobial MDR infections. These findings highlight the importance of multidisciplinary orthoplastic-infectious diseases care, MDR screening, strengthened microbiology capacity, and antimicrobial stewardship in conflict-associated trauma management.