title: Infection in conflict wounded.
abstract: Although mechanisms of modern military wounding may be distinct from those of ancient conflicts, the infectious sequelae of ballistic trauma and the evolving microbial flora of war wounds remain a considerable burden on both the injured combatant and their deployed medical systems. Battlefield surgeons of ancient times favoured suppuration in war wounding and as such Galenic encouragement of pus formation would hinder progress in wound care for centuries. Napoleonic surgeons eventually abandoned this mantra, embracing radical surgical intervention, primarily by amputation, to prevent infection. Later, microscopy enabled identification of microorganisms and characterization of wound flora. Concurrent advances in sanitation and evacuation enabled improved outcomes and establishment of modern military medical systems. Advances in medical doctrine and technology afford those injured in current conflicts with increasing survivability through rapid evacuation, sophisticated resuscitation and timely surgical intervention. Infectious complications in those that do survive, however, are a major concern. Addressing antibiotic use, nosocomial transmission and infectious sequelae are a current clinical management and research priority and will remain so in an era characterized by a massive burden of combat extremity injury. This paper provides a review of infection in combat wounding from a historical setting through to the modern evidence base.
authors.affiliation: Academic Department of Military Trauma and Surgery, Royal Centre for Defence Medicine, Academic and Research Directorate, West Wing, Institute of Research and Development, Vincent Drive, Birmingham B15 2SQ, UK.
authors.forename: W G P
authors.initials: WG
authors.lastname: Eardley
authors.forename: K V
authors.initials: KV
authors.lastname: Brown
authors.forename: T J
authors.initials: TJ
authors.lastname: Bonner
authors.forename: A D
authors.initials: AD
authors.lastname: Green
authors.forename: J C
authors.initials: JC
authors.lastname: Clasper
mesh_terms: D000150:Acinetobacter; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001458:Bandages; D003428:Cross Infection / Q000382:microbiology*; D049672:History, 19th Century; D049673:History, 20th Century; D049674:History, 21st Century; D049690:History, Ancient; D049691:History, Medieval; D006801:Humans; D008887:Military Medicine / Q000379:methods* / Q000639:trends; D008889:Military Personnel; D014857:Warfare; D014946:Wound Infection / Q000266:history* / Q000382:microbiology / Q000628:therapy*
chemical_list: D000890:Anti-Infective Agents