{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T14:16:25Z","timestamp":1789049785747,"version":"build-2803163510"},"reference-count":23,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T00:00:00Z","timestamp":1788998400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100014434","name":"the Polish National Agency for Academic Exchange","doi-asserted-by":"crossref","award":["grant no. BPN\/GIN\/2024\/1\/00037\/UMOWA\/00001"],"award-info":[{"award-number":["grant no. BPN\/GIN\/2024\/1\/00037\/UMOWA\/00001"]}],"id":[{"id":"10.13039\/501100014434","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Combat-related infection research is overwhelmingly skewed toward extremity injuries because of the effectiveness of modern body armor. This creates a critical knowledge gap regarding the microbiological dynamics of non-limb anatomical sites, particularly in the context of intense warfare. This study evaluates the wound microflora of 51 Ukrainian soldiers during the second phase of the conflict with Russia, focusing on head and torso injuries. A key objective was to investigate how blast-induced acoustic barotrauma\u2014including tympanic membrane perforation and mucosal damage\u2014acts as a potential modifier of local microbiota composition in the ear, nose, and oropharyngeal regions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Superficial swabs (58 total) were collected from torso, extremity, and ENT (ear, nose, oropharynx) wounds of 51 military patients undergoing prolonged hospitalization at the Kolomiychenko Institute of Otolaryngology in Kyiv. Microorganisms were isolated using selective media and identified via MALDI-TOF mass spectrometry. Identification was confirmed by 16S rRNA gene sequencing. The study received institutional approval from the NaUKMA Research Ethics Committee on June 9, 2025 (Protocol No. 8).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The analysis distinguished 209 isolates at the species level, covering 74 species and 36 genera. Gram-positive bacteria were the largest (71%) and most diverse group. Although extremity infections aligned with the established paradigm of Gram-negative dominance (63%), ENT wounds showed a dramatic Gram-positive prevalence (74%-97%), with Staphylococcus species representing 71% of aural isolates. Torso wounds exhibited an even distribution of Gram types (50\/50), characterized by an unusually high frequency of Enterococcus (38.5%). ESKAPE pathogens accounted for 24% of all identified microorganisms, with S. aureus being most pronounced in the head area.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>These findings demonstrate that blast-induced barotrauma is not only a mechanical injury but a significant modifier of local microbiological environments. The study\u2019s strength lies in providing a comprehensive comparison of head, torso, and limb wounds, revealing that site-specific physiological conditions fundamentally alter colonizing microbiota. A primary challenge identified is the risk of diagnostic masking, where abundant commensal flora may obscure aggressive pathogens. Consequently, implementing site-specific diagnostic protocols and susceptibility testing is essential to optimize targeted antimicrobial therapy and improve the clinical prognosis for wounded soldiers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag420","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:17:30Z","timestamp":1788520650000},"source":"Crossref","is-referenced-by-count":0,"title":["Anatomical Site-Specific Microbiological Divergence in Combat-Related Injuries During the Ukraine Conflict: A Comparative Analysis of Head, Torso, and Extremity Wounds"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9586-7069","authenticated-orcid":false,"given":"Oleksandra","family":"Pryshchepa","sequence":"first","affiliation":[{"name":"Centre for Modern Interdisciplinary Technologies, Institute of Advanced Studies, Nicolaus Copernicus University in Torun , Torun,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5848-0102","authenticated-orcid":false,"given":"Ewelina","family":"Sibi\u0144ska","sequence":"additional","affiliation":[{"name":"Centre for Modern Interdisciplinary Technologies, Institute of Advanced Studies, Nicolaus Copernicus University in Torun , Torun,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-9957-9260","authenticated-orcid":false,"given":"Viktoriia","family":"Avramenko","sequence":"additional","affiliation":[{"name":"Faculty of Natural Sciences, Department of Chemistry, National University of Kyiv-Mohyla Academy , Kyiv,","place":["Ukraine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6040-8134","authenticated-orcid":false,"given":"Oleksandr","family":"Bespalko","sequence":"additional","affiliation":[{"name":"Faculty of Natural Sciences, Department of Chemistry, National University of Kyiv-Mohyla Academy , Kyiv,","place":["Ukraine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5963-0483","authenticated-orcid":false,"given":"Yegor","family":"Babenko","sequence":"additional","affiliation":[{"name":"Department of Otorhinolaryngology, Pediatric Otorhinolaryngology, and Audiology, Shupyk National Healthcare University of Ukraine , Kyiv,","place":["Ukraine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6615-9263","authenticated-orcid":false,"given":"Svitlana","family":"Yaremchuk","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Shupyk National Healthcare University of Ukraine , Kyiv,","place":["Ukraine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6169-3099","authenticated-orcid":false,"given":"Micha\u0142","family":"Z\u0142och","sequence":"additional","affiliation":[{"name":"Centre for Modern Interdisciplinary Technologies, Institute of Advanced Studies, Nicolaus Copernicus University in Torun , Torun,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7828-1349","authenticated-orcid":false,"given":"Polina","family":"Vakuliuk","sequence":"additional","affiliation":[{"name":"Faculty of Natural Sciences, Department of Chemistry, National University of Kyiv-Mohyla Academy , Kyiv,","place":["Ukraine"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1594-0623","authenticated-orcid":false,"given":"Pawe\u0142","family":"Pomastowski","sequence":"additional","affiliation":[{"name":"Centre for Modern Interdisciplinary Technologies, Institute of Advanced Studies, Nicolaus Copernicus University in Torun , Torun,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,9,10]]},"reference":[{"key":"2026091010014617600_usag420-B1","doi-asserted-by":"publisher","first-page":"e141348","DOI":"10.5812\/amh-141348","article-title":"Prevention of combat-related infections: a review of the literature","volume":"21","author":"Darvishi","year":"2023","journal-title":"Ann Mil Heal Sci Res"},{"key":"2026091010014617600_usag420-B2","doi-asserted-by":"publisher","first-page":"2848","DOI":"10.1017\/S0950268816000431","article-title":"Microbiology and risk factors associated with war-related wound infections in the Middle East","volume":"144","author":"Sahli","year":"2016","journal-title":"Epidemiol Infect"},{"key":"2026091010014617600_usag420-B3","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1093\/milmed\/usab131","article-title":"Multidrug-resistant and virulent organisms trauma infections: trauma infectious disease outcomes study initiative","volume":"187","author":"Mende","year":"2022","journal-title":"Mil Med"},{"key":"2026091010014617600_usag420-B4","doi-asserted-by":"publisher","first-page":"204","DOI":"10.1098\/rstb.2010.0225","article-title":"Infection in conflict wounded","volume":"366","author":"Eardley","year":"2011","journal-title":"Philos Trans R Soc B Biol Sci"},{"key":"2026091010014617600_usag420-B5","doi-asserted-by":"publisher","first-page":"2583","DOI":"10.1128\/JCM.00556-14","article-title":"Microbial profiling of combat wound infection through detection microarray and next-generation sequencing","volume":"52","author":"Be","year":"2014","journal-title":"J Clin Microbiol"},{"key":"2026091010014617600_usag420-B6","doi-asserted-by":"publisher","first-page":"394","DOI":"10.1038\/s43856-025-01056-6","article-title":"War impact on antimicrobial resistance and bacteriological profile of wound infections in Ukraine","volume":"5","author":"Holubnycha","year":"2025","journal-title":"Commun Med (Lond)"},{"key":"2026091010014617600_usag420-B7","doi-asserted-by":"publisher","first-page":"tkad059","DOI":"10.1093\/burnst\/tkad059","article-title":"The role of the skin microbiome in wound healing","volume":"12","author":"Yang","year":"2024","journal-title":"Burn Trauma"},{"key":"2026091010014617600_usag420-B8","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1089\/sur.2017.240","article-title":"Early infections complicating the care of combat casualties from Iraq and Afghanistan","volume":"19","author":"Weintrob","year":"2018","journal-title":"Surg Infect (Larchmt)"},{"key":"2026091010014617600_usag420-B9","doi-asserted-by":"publisher","first-page":"1624","DOI":"10.36740\/WLek\/209517","article-title":"Healthcare associated infections in patients with combat wounds and antimicrobial resistance of the responsible pathogens in Ukraine: results of a multicenter study (2022-2024)","volume":"78","author":"Salmanov","year":"2025","journal-title":"Wiad Lek"},{"key":"2026091010014617600_usag420-B10","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.jhin.2024.06.011","article-title":"Temporal evolution of bacterial species and their antimicrobial resistance characteristics in wound infections of war-related injuries in Ukraine from 2014 to 2023","volume":"152","author":"Kovalchuk","year":"2024","journal-title":"J Hosp Infect"},{"key":"2026091010014617600_usag420-B11","doi-asserted-by":"publisher","first-page":"355","DOI":"10.14739\/2310-1210.2025.5.338948","article-title":"Antimicrobial resistance and genomic epidemiology of bacterial war-wound infections: Ukraine, 2014-2023","volume":"27","author":"Kovalchuk","year":"2025","journal-title":"Zaporozhye Med J"},{"key":"2026091010014617600_usag420-B12","doi-asserted-by":"publisher","first-page":"615","DOI":"10.22141\/2224-0586.20.7.2024.1767","article-title":"Evolution of the microbiota of wound infections in military personnel during the full-scale Russian invasion: a retrospective cohort study (2022\u20132024)","volume":"20","author":"Beley","year":"2024","journal-title":"\u0415\u041c"},{"key":"2026091010014617600_usag420-B13","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1016\/j.eimc.2024.04.004","article-title":"Caracterizaci\u00f3n de las infecciones de herida entre pacientes procedentes de la guerra ruso-ucraniana en un hospital role 4","volume":"42","author":"Rodero Rold\u00e1n","year":"2024","journal-title":"Enferm Infecc Microbiol Clin"},{"key":"2026091010014617600_usag420-B14","doi-asserted-by":"publisher","first-page":"12","DOI":"10.33743\/2308-1066-2024-1-12-17","article-title":"Study of the population level and microecological indicators of the microbiota of the early contents of combat injuries","volume":"103","author":"Kutasevych","year":"2024","journal-title":"Dermatol Venerol"},{"key":"2026091010014617600_usag420-B15","doi-asserted-by":"publisher","DOI":"10.1186\/s13104-017-2481-4","article-title":"Bacterial flora of combat wounds from Eastern Ukraine and time-specified changes of bacterial recovery during treatment in Ukrainian military hospital","volume":"10","author":"Kovalchuk","year":"2017","journal-title":"BMC Res Notes"},{"key":"2026091010014617600_usag420-B16","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1533\/9780857093301.2.155","volume-title":"Advanced Wound Repair Therapies","author":"Day","year":"2011"},{"key":"2026091010014617600_usag420-B17","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.heares.2016.01.004","article-title":"Mechanical damage of tympanic membrane in relation to impulse pressure waveform\u2014a study in chinchillas","volume":"340","author":"Gan","year":"2016","journal-title":"Hear Res"},{"key":"2026091010014617600_usag420-B18","doi-asserted-by":"publisher","first-page":"507","DOI":"10.1038\/s41579-024-01035-z","article-title":"The wound microbiota: microbial mechanisms of impaired wound healing and infection","volume":"22","author":"Uberoi","year":"2024","journal-title":"Nat Rev Microbiol"},{"key":"2026091010014617600_usag420-B19","doi-asserted-by":"publisher","first-page":"710","DOI":"10.1007\/s00248-016-0867-9","article-title":"Bacterial contribution in chronicity of wounds","volume":"73","author":"Rahim","year":"2017","journal-title":"Microb Ecol"},{"key":"2026091010014617600_usag420-B20","doi-asserted-by":"publisher","first-page":"91","DOI":"10.1089\/wound.2020.1176","article-title":"Current in vitro biofilm-infected chronic wound models for developing new treatment possibilities","volume":"10","author":"Thaarup","year":"2021","journal-title":"Adv Wound Care"},{"key":"2026091010014617600_usag420-B21","doi-asserted-by":"publisher","first-page":"435","DOI":"10.1016\/B978-0-12-819265-8.00100-5","volume-title":"Comprehensive Gut Microbiota","author":"Corvec","year":"2022"},{"key":"2026091010014617600_usag420-B22","doi-asserted-by":"publisher","first-page":"333","DOI":"10.12968\/jowc.2008.17.8.30796","article-title":"Biofilms and chronic wound inflammation","volume":"17","author":"Wolcott","year":"2008","journal-title":"J Wound Care"},{"key":"2026091010014617600_usag420-B23","doi-asserted-by":"publisher","first-page":"1174","DOI":"10.1097\/SLA.0000000000003053","article-title":"Staphylococcus aureus biofilm infection compromises wound healing by causing deficiencies in granulation tissue collagen","volume":"271","author":"Roy","year":"2020","journal-title":"Ann Surg"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag420\/71019165\/usag420.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag420\/71019165\/usag420.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T14:01:52Z","timestamp":1789048912000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article\/doi\/10.1093\/milmed\/usag420\/8789963"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,10]]},"references-count":23,"URL":"https:\/\/doi.org\/10.1093\/milmed\/usag420","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,10]]},"article-number":"usag420"}}