Молодежный инновационный вестник

2415-7805

Федеральное государственное бюджетное образовательное учреждение высшего образования "Воронежский государственный медицинский университет имени Н.Н. Бурденко" Министерства здравоохранения Российской Федерации

11513

Conference Proceedings

Antibiotics in Military Surgery: From N.N. Burdenko to the Present Day

Petrova

Polina Alexandrovna

papetrova04@mail.ruhttps://orcid.org/0009-0006-1856-3807Grosheva

Ekaterina Sergeevna

Candidate of Medical Sciences, Associate ProfessorK.andre@mail.ruhttps://orcid.org/0000-0001-5432-3233

Burdenko Voronezh State Medical University

01102026

15S1262264

12032026

11042026

2026

Military surgery has undergone a long evolutionary process in the use of antibiotics, starting with the practice of Academician N.N. Burdenko, who pioneered the widespread use of antiseptics and sulfanilamides during the Great Patriotic War. Further development has led to the widespread use of antibiotics from various groups, the improvement of principles for the prevention and treatment of wound infections, the creation of antibiotic therapy standards, and the development of individualized drug regimens based on the type of injury, the nature of the infection, and the epidemiological situation. Modern achievements in the fields of microbiology, pharmacokinetics, and molecular biology make it possible to optimize the use of antibiotics, minimizing the risks of microbial resistance and drug side effects, and improving the quality of medical care for injured military personnel and their survival rates.

wartimemedicineantibioticswound infections

военное времямедицинаантибиотикираневые инфекции

The activities of such famous scientists as Nikolai Nilovich Burdenko and Zinaida Vissarionovna Ermolyeva were directly related to the invention and practical use of penicillin for the treatment of wounded and sick soldiers in the army and in the country's rear medical institutions, and after the war, the creation of factories for the manufacture of broadspectrum antibiotics. The main goal of the scientific and practical activities of these scientists, especially during the Great Patriotic War of 1941-1945. the highest possible percentage of recovery and return to service of wounded and sick soldiers of the Red Army. The first period of the Great Patriotic War was marked by a catastrophic increase in infectious complications from wounds. N.N. Burdenko noted that "infectious complications became the main cause of mortality among the wounded in the first months of the war." This alarming statistic required an immediate reassessment of existing methods for combating wound infection. Statistics confirm the critically high level of postoperative mortality due to infectious complications that existed before the introduction of antibiotics. According to archival data, in 1941-1942, 65-80% of wounded soldiers with musculoskeletal injuries developed infectious complications. The highest mortality rates were observed in cases of anaerobic infections. Zinaida Yermolyeva, along with a team led by Nikolai Burdenko, the chief surgeon of the Red Army, traveled to the First Baltic Front to test a new medication in combat conditions. After spending six months in military hospitals, she concluded, "Not a single limb was amputated." Under Burdenko's direct supervision, protocols for the use of penicillin in field surgery were developed. The proposed dosing and administration schedules were successfully tested in evacuation hospitals on the Western Front. These methods became the foundation for new standards in military field surgical practice. The introduction of antibacterial drugs necessitated a revision of established principles. The ability to effectively control infection using penicillin prevented many early limb amputations in cases of gunshot fractures, leading to improved functional outcomes. The first clinical observations obtained during the use of penicillin demonstrated a significant reduction in the number of infectious complications. Statistical data from 1943-1944 show a three-fold decrease in the number of cases of gas gangrene compared to the early period of the war. The frequency of septic complications in chest injuries decreased from 42% to 11-15% after the start of systemic use of antibacterial drugs. Antibiotic therapy led to a change in the tactics for preserving damaged limbs. The use of penicillin created favorable conditions for the successful performance of organ-preserving surgeries due to the effective control of wound infections. This allowed for the preservation of functionally significant areas. The positive impact on the restoration of work capacity and the reduction of disability rates among military personnel was evident. After the end of the Great Patriotic War, the USSR entered an active phase of developing industrial production of antibacterial drugs. Drawing on the experiences of the war years, the Soviet pharmaceutical industry significantly increased the production of penicillin. "In the USSR, the work of Zinaida Vissarionovna Ermolyeva (1898-1974) and her colleagues allowed for the production of penicillin during the Great Patriotic War and its use on the front lines for the treatment of wound infections. Scientific research led to the development of numerous new types of antibiotics with enhanced capabilities for targeting microorganisms. These new classes include tetracyclines, aminoglycosides, macrolides, and fluoroquinolones, which have demonstrated high activity against various pathogens.Microorganisms gradually adapted to the effects of penicillin, developing defense mechanisms and reducing their sensitivity to the drug. This led to the emergence of penicillin-resistant bacterial strains, necessitating the development of alternative medications. The mid-1950s saw the introduction of a new generation of broad-spectrum antibiotics into clinical practice. Tetracyclines and chloramphenicol joined the arsenal of military surgeons, demonstrating effectiveness against gram-positive and gram-negative bacteria, including those responsible for anaerobic infections. Their introduction overcame the limitations of penicillin therapy and reduced reliance on specialized medications. After the end of World War II, international scientific research focused on the development of semi-synthetic penicillins and cephalosporins, which had a broader spectrum of antibacterial activity. Methicillin (1959) and cefazolin (1967) were significant breakthroughs due to their resistance to -lactamases and their high efficacy against staphylococcal infections. These discoveries overcame the limitations of natural penicillin, which was particularly important in treating the septic complications of combat wounds. By the 1970s, the fundamental principles of rational antibiotic therapy had been established based on international experience. The key aspect of rational therapy was the combination of drugs with different mechanisms of action to prevent the development of resistance. Special attention was given to limiting the use of broad-spectrum antibiotics in the absence of laboratory confirmation of infection. These measures helped to reduce the incidence of hospital-acquired infections in hospitals located in conflict zones. The key factors contributing to the development of antibiotic resistance in microorganisms are the unjustified use of broad-spectrum antibiotics and the high bacterial load associated with wounds. The clinical picture in surgical departments at field stages confirms the high frequency of infectious tissue lesions in wounds. This high prevalence of such cases creates a significant bacterial load that requires the widespread use of antibiotics, which creates favorable conditions for the selection of resistant strains. Increased antibiotic resistance leads to a decrease in the effectiveness of standard treatment regimens for wound infections and a reduction in the overall effectiveness of the prescribed therapy. As a result, it is often necessary to switch to reserve drugs that have a narrower spectrum of action or a different mechanism of action. Local use of antimicrobial drugs should complement, rather than replace, surgical procedures, and should be used strictly according to indications in cases with a high risk of infection. Systemic antibiotic prophylaxis requires strict adherence to indications, dosages, and treatment durations to minimize side effects and reduce the risk of antibiotic resistance. The implementation of de-escalation therapy algorithms allows for the initiation of broad-spectrum antibiotic treatment in cases of high clinical uncertainty, with subsequent narrowing of the treatment spectrum based on the results of microbiological studies. To prevent the development of resistant strains, new pharmacodynamic parameters have been integrated into clinical practice, including the MPC (mutant prevention concentration) indicator, which represents the minimum concentration necessary to prevent the formation of resistant mutants. The reduction in infectious mortality rates is directly linked to the stages of implementation of antibiotic therapy. In the era of N.N. Burdenko, specific antibacterial therapy was virtually nonexistent, and wound treatment was accompanied by a high rate of infectious complications. "The discovery of penicillin is considered a crucial turning point in the history of antibacterial therapy for infections." This innovation marked a shift from ineffective local measures to targeted antibacterial protection, leading to a significant reduction in the number of fatal infections. Consequently, there is a direct correlation between the availability of penicillin and the decrease in infectious mortality rates. The current challenge is the problem of antibiotic resistance, which requires the development of personalized therapy algorithms. The emergence of multidrug-resistant microbial strains in conflict zones necessitates the implementation of microbiological monitoring. The analysis of resistance patterns allows for the adjustment of empirical therapy based on current local epidemiological data. The introduction of rapid diagnostics and antibiotic susceptibility testing is essential for maintaining the effectiveness of antimicrobial therapy in the field. The post-war period was characterized by the mass production of broad-spectrum antibiotics and the standardization of their use in combat injuries. The widespread use of new antibiotics has led to a steady improvement in outcomes in military surgery and a decrease in the number of complications associated with sepsis and purulent processes. The increasing resistance to antibiotics calls into question the effectiveness of traditional empiric therapy standards and requires a revision of the algorithms for selecting drugs in cases of injury. The adaptation of protocols based on microbiological diagnostics and the introduction of new approaches to combination therapy are necessary measures to further reduce infectious mortality in modern conditions.

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