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Full-scale hostilities in Ukraine led to an unprecedented number of victims with serious injuries, including gunshot wounds, broken bones, and mine-explosive injuries. Wound infections are one of the main causes of non-combat losses of personnel. A prerequisite for the development of a wound infection, among other things, is high microbial contamination of combat wounds. Major bacteria causing such infections are staphylococci (Staphylococcus aureus, S. epidermidis), streptococci (Streptococcus pyogenes, St. agalictiae), enterococci (Enterococcus faecalis), gram-negative bacteria (Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, Acinetobacter baumannii), anaerobic bacteria (Clostridium perfringens, Bacterioides spp.), etc. Modern data indicate a change in the current species composition of causative agents of wound infections, an increase both in the polyresistance of the microbiota to antibacterial drugs and in the frequency of biofilm formation protecting pathogenic microorganisms from antimicrobial therapy and the patient's immune response. Such purulent bacterial infections require new approaches to therapy. Taking into account the large number of combat injuries in Ukraine, the use of bacteriophages as specific agents for the biological control of pathogenic microbiota is of particular importance. In view of the nature of injuries, phage preparations intended for the treatment of purulent-surgical infections of wound and burn surfaces are considered the most promising and in demand today. This review summarizes modern data on the use of phage preparations in clinics and in orthopedics and traumatology in particular. Issues of the delivery of phages to the focus of infection, their effective dose, duration of therapy, and the possibility of combining it with antibiotic therapy are discussed. Information about phage therapy programs that have already been implemented in some countries is presented. The advantages and disadvantages of the use of bacteriophages for personalized therapy of severe patients are highlighted, and the prospects for further research are indicated. [ABSTRACT FROM AUTHOR]

Background/Aim. Antimicrobial resistance (AMR) is a huge challenge for all countries. This problem has reached particularly alarming proportions in Ukraine, which has been fighting on the battlefield for its independence for three years now. Priorities to address AMR in human health include research and development of novel antibacterial preparations. In this context due to their unique properties, bacteriophageshave been perceived as promising tools in combating bacterial pathogens. The goals of our work were to investigate the microbiological profiles of wound injuries and to isolate bacteriophages capable of lysing the most relevant causative agents of soft and bone tissue infections. Methods. Microorganisms were isolated from clinical material through initial inoculation on differential diagnostic and specialized nutrient media. Bacteria were identified by morphological and biochemical tests. The disk diffusion method was used to evaluate antibiotic sensitivity. The Vitek system was additionally used for the identification and bacterial susceptibility testing. Bacteriophages were isolated from sewage water samples by the overlay agar method. The morphology of newly isolated bacteriophages was studied using transmission electron microscopy. Results. As result of our work, over 100 clinical isolates of microorganisms belonging to nine different species were isolated and identified: Acinetobacter baumannii, Enterobacter cloacae, Escherichia coli, Proteus mirabilis, Pseudomonas aeruginosa, Citrobacter freundii, Klebsiella pneumoniae, Klebsiella aerogenes and Staphylococcus aureus. Based on the obtained data, it can be concluded that K. pneumoniae, P. aeruginosa and S. aureus were the dominant pathogenic microorganisms found in wound microbiota. In this study, we have also isolated bacteriophages specific to K. pneumoniae, P. aeruginosa, A. baumannii, E. coli, P. mirabilis and S. aureus. The iIsolated bacteriophages differed in their host range and morphological characteristics. In general, the isolated bacteriophages belonged to the myo-like, sipho-like, and podo-like viruses. Due to their strong lytic activity in vitro and high titers, over 30 isolates of bacteriophages have been selected for further studies. Conclusions. This work has been funded by the National Research Foundation of Ukraine (grant No. 2022.01/0065) and represents the initial large-scale effort to develop a collection of phages targeting relevant bacteria, through the collaboration of multiple institutions. Additional research is required to establish the role of phages in modern medicine, to conduct clinical trials and to facilitate the implementation of phage therapy into clinical practice. [ABSTRACT FROM AUTHOR]