Analysis of battlefield injuries from Ukraine demonstrates unique patterns of multidrug-resistant pathogens, including high prevalence of carbapenem-resistant Enterobacteriaceae and Acinetobacter species adapted to combat environments. The microbial signatures differ markedly from civilian trauma cases, reflecting environmental contamination from soil, debris, and prolonged field conditions before medical evacuation. This battlefield pathogen data provides crucial insights for antimicrobial stewardship in conflict medicine, where standard infection protocols may prove inadequate. The findings echo historical patterns from Iraq and Afghanistan conflicts but show evolution toward more resistant strains, likely reflecting both regional bacterial ecology and widespread antibiotic use in conflict zones. For emergency medicine practitioners, these results underscore the importance of broad-spectrum empirical coverage and rapid culture-guided therapy adjustment in war-related trauma. The research also illuminates how extreme stress environments accelerate bacterial resistance development, offering a preview of potential civilian healthcare challenges as resistant organisms spread beyond conflict zones through medical evacuations and population displacement.