Researchers have detected alarming signs of bacterial infections in Ukraine, with some strains resistant to multiple types of antibiotics. Patients show little to no improvement even after treatment, while these microbes slow wound healing and pose a serious threat to public health. If left unchecked, the spread of these unstoppable antibiotic-resistant bacteria could trigger a full-blown epidemic.

In recent years, particularly since the onset of the war, experts have conducted numerous studies on the intensity of antimicrobial resistance in Ukraine. Findings from these studies indicate a continuous deterioration of the situation.

Infection and antimicrobial resistance rank among the most pressing public health challenges in war-torn countries. In Ukraine, however, the dire state of the healthcare system, inadequate supply conditions, and the lack of regulation in the pharmaceutical supply chain exacerbate the problem.

A study published on nature.com evaluated the impact of war on wound microbiomes and the distribution of antimicrobial resistance among patients in Ukrainian hospitals. This research was conducted at the Sumy Regional Centre for Disease Prevention and Control under the Ukrainian Ministry of Health. Data were collected between January and April 2024 from analyses of wound samples taken from patients in three civilian hospitals in Sumy.

Experts examined patients with combat injuries treated in civilian hospitals in northeastern Ukraine during the same period. Researchers clearly demonstrated the presence of multiple strains of antibiotic-resistant bacteria in the samples, indicating their presence within the patients’ bodies.

Bacteria were isolated in 56.16% of the samples, with gram-negative bacteria, which are resistant to antibiotics, being predominant. The most frequently detected species were A. baumannii (36%), E. faecalis (12%), and B. cereus (12%). These bacteria can cause a range of serious conditions, including pneumonia, sepsis, blood poisoning, wound infections, urinary tract infections, as well as vomiting and diarrhoea.

The prevalence of multi-resistance, defined as resistance to three or more different groups of antibiotics, was found to be 84.6% among the examined samples.

The study revealed that microorganisms were isolated from approximately half of the wound samples. Additionally, the results indicated that mixed cultures were frequently isolated, occurring in 24.4% of the samples.

The scientific summary highlighted the predominance of gram-negative bacilli (antibiotic-resistant bacilli), with the frequency of multi-resistance being above average. Their presence poses a significant risk, as it not only prolongs the healing process but also facilitates the spread of multi-resistant strains within healthcare institutions.

Ukraine’s other war: the battle against drug-resistant bacteria https://t.co/vymDUzyBy4 pic.twitter.com/LtR2JSUVF2

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Researchers attribute Ukraine’s high mortality rate to the large number of casualties, the severity of injuries, a lack of medical care, and a significant number of refugees. Infection and sepsis remain common consequences of combat injuries, often leading to death.

Soldiers’ wounds are typically contaminated with soil and are most often treated in facilities with inadequate infection control, resulting in high rates of wound infections.

Another pressing concern related to the war is antimicrobial resistance (AMR). Combat injuries may accelerate the emergence of multi-drug resistant (MDR) organisms, and the war contributes to the rise of AMR.

Continuous monitoring of combat wounds and determining the antibiotic resistance of isolated pathogens are essential components in improving the care of trauma patients and in preventing the global spread of antibiotic resistance.

Previous reports concerning fatalities have highlighted the sluggishness of Ukrainian medical care and the primary infection of wounds.

The poor healthcare system also contributes to the epidemic risk in Ukraine

According to a report, infection prevention and control measures, such as recommended hand sanitisation and the monitoring, evaluation, and feedback of hospital staff, are inadequate in Ukraine.

Soldiers are generally treated in at least two institutions before being permanently hospitalised: at a stabilisation point, where they receive medical care, and in the nearest civilian or military hospital to the frontline.

These institutions, where the prevalence of MDR organisms (multi-drug resistant bacteria that resist various types of antibiotics) is high, are unsuitable for infection control, potentially leading to the contamination of wounds with hospital bacterial flora, which can further spread these microorganisms to other healthcare facilities.

This hypothesis aligns with previous reports and the findings of an experimental study conducted by the Ukrainian public health centre in 2021 regarding hospital infections. These studies highlight the primary role of hospital-acquired bacterial flora in causing wound infections in patients, as well as the dominant role of gram-negative bacteria as pathogens in such infections. The increasing number of soldiers requiring treatment for infected wounds in civilian hospitals may contribute to the persistence of hospital-acquired infectious flora.

Investigations conducted by researchers have shown that among the gram-negative bacteria isolated from patients treated in Ukrainian civilian hospitals, there is a high proportion of resistant strains that do not respond to antibiotics.