Early Microbiological Patterns in Combat-Related Extremity Wounds During the Gaza Conflict: A Retrospective Cohort...

Combat-related extremity injuries are characterized by extensive soft-tissue damage and environmental contamination, but early wound microbiology varies across conflicts and geographic regions. Contemporary data from the Gaza conflict remain limited. This study characterized early microbiological findings and pathogen distribution in operatively managed combat-related extremity wounds.

We conducted a retrospective, descriptive study at a Level I trauma center between October 7, 2023, and December 31, 2024. The institutional ethics committee approved the study and waived informed consent. Of 758 admitted soldiers, 352 sustained orthopedic trauma. Patients were included if a bacterial or fungal organism was isolated from a deep operative bone or soft-tissue culture obtained within 5 days of admission in the presence of clinical concern for infection. Patient characteristics were summarized descriptively. Isolate-level comparisons were considered exploratory because multiple isolates originated from individual patients and no adjustment for intrapatient clustering was performed.

Early culture-positive infection occurred in 1.8% of admitted combat casualties and 4.0% of orthopedic trauma patients. Fourteen patients met inclusion criteria, yielding 39 microbiological isolates. Median age was 21.9 years (IQR 21.6-24.2), and median injury severity score (ISS) was 25.0 (IQR 19.0-29.0). Polymicrobial infections occurred in 78.6% of patients. Gram-negative organisms accounted for 46.2% of isolates, Gram-positive organisms for 43.6%, and fungi for 10.3%. The most common pathogens were Enterococcus faecium, Bacillus cereus, and Escherichia coli. Multidrug-resistant organisms were identified in 28.6% of patients and occurred exclusively among Gram-negative isolates. Microbiological subgroup distributions varied by injury mechanism in exploratory isolate-level analyses; these comparisons were not adjusted for intrapatient clustering.

Early culture-positive combat wounds demonstrated heterogeneous and frequently polymicrobial microbiology, with similar proportions of Gram-positive and Gram-negative organisms. These findings provide contemporary data from a rapid-evacuation military trauma system but should be interpreted cautiously because of the small, single-center cohort, clinically directed sampling, and absence of clinical outcome analysis. Larger multicenter studies using standardized sampling and longitudinal follow-up are needed to determine whether early isolates predict subsequent wound infection or clinical outcomes.