Antimicrobial Resistance Research to Improve Outcomes of Traumatic Wounds (ARROW): Preliminary results from a prospective observational cohort in Ukraine

Introduction: Traumatic wound infections are common contributors to morbidity and mortality among casualties in war and conflict, including the current Russian invasion of Ukraine. Due to accelerating antibiotic resistance worldwide, complicated wound infections are only expected to increase, particularly during large-scale combat operations. We developed the Antimicrobial Resistance Research to Improve Outcomes of Traumatic Wounds (ARROW) study to better understand the changing epidemiology, microbiology, and associated outcomes of wound infections during the current war in Ukraine. We describe an update on the study protocol and provide preliminary data on patients with traumatic wounds in Ukraine.

Methods: ARROW is a multicenter prospective observational study of adult patients with traumatic wounds admitted to one of the five participating hospitals in Ukraine. Study participants will be followed during hospitalization for a maximum of 28 days, or until discharge, transfer, or death. Relevant participant demographics, injury characteristics, clinical care, and wound outcomes will be collected from the clinical charts along with serial swabs and photographs of the traumatic wound(s) at day 0 (enrollment), 7, 14, and 28 (or day of discharge). Wound swabs will be cultured and processed in Ukraine, with whole genome sequencing and antimicrobial susceptibility testing of the isolates performed in the United States.

Results: ARROW will launch data collection in December 2024; with preliminary results presented at SOMA 2025. We will provide descriptive statistics for all baseline demographic and clinical variables; calculate the prevalence of all wound and patient outcomes as counts and percentages with 95% confidence intervals; and provide initial analyses of the associations between baseline patient and wound characteristics, and clinical care, with patient outcomes, including amputation, sepsis, and mortality. Preliminary wound culture data will be analyzed to identify infecting isolates and associated drug resistance patterns among infected trauma-related wounds and their associated injury and healthcare-related factors and outcomes.

Discussion: ARROW provides a framework for data collection of patients with traumatic wounds in Ukraine. Early data among this patient cohort is anticipated to have significant morbidity with high rates of antimicrobial resistance among culture isolates.

Conclusion: Preliminary data will inform the continued care of traumatic wound infections and their complications in Ukraine; future clinical trials of promising interventions for prevention and treatment of traumatic wounds; and current clinical practice guidelines and training curricula to improve readiness, increase survivability, and reduce costs associated with traumatic wound infections during current and future conflicts.

Disclosure: This effort was funded under MTEC solicitation MTEC-24-01-MPAI and is funded by Combat Casualty Research Program (CCCRP) under the Department of Defense. The views and conclusions contained herein are those of the authors and should not be interpreted as necessarily representing the official policies or endorsements, either expressed or implied, of the U.S. Government.