Ukraine’s War Zone Fuels Dangerous Surge in Bacterial Drug Resistance

The invasion of Ukraine by Russia has led to a dangerous escalation in bacterial drug resistance, as evidenced by a recent case report involving an injured Ukrainian soldier who contracted six extensively drug-resistant bacteria. Of particular concern is one bacterium that displayed resistance to all tested antibiotics. Health experts are raising the alarm that these nearly untreatable germs will likely spread beyond Ukraine’s borders, posing a significant threat to healthcare systems worldwide.

The rise of antibiotic resistance has long been recognized as a critical global health issue, with millions of deaths attributed to antimicrobial resistance each year. War conditions exacerbate this crisis by creating an environment conducive to developing and spreading drug-resistant bacteria. Ars Technica reported that the chaos and devastation of war provide ideal conditions for antimicrobial resistance to flourish.

Severe and complex war wounds are often contaminated with environmental bacteria, dust, soil, and metals from explosives. These factors can contribute to developing and sharing genetic determinants of drug resistance among bacteria. Various types of microbes in dirty wounds further facilitate the exchange of drug-resistant traits. 

Injured individuals in war-torn regions often encounter broken and overwhelmed healthcare systems that lack proper infection control measures. Additionally, laboratory testing for bacterial infections is often unavailable. In these circumstances, broad-spectrum antibiotics are frequently administered to save lives during evacuations, which involve moving patients through multiple healthcare facilities before reaching safety.

The indiscriminate use of broad-spectrum drugs is known to fuel drug resistance. Furthermore, transferring patients from one chaotic healthcare facility to another increases the risk of acquiring and spreading multi-drug resistant infections, also known as nosocomial infections, from bacteria in healthcare settings. 

In 2021, Ukrainian researchers conducted a study to assess the prevalence of drug resistance in bacteria within military hospitals. The study revealed significantly higher rates of resistance compared to civilian hospitals in Ukraine and Europe. For example, among Acinetobacter baumannii isolates, a common cause of nosocomial infections, 68 percent showed resistance to carbapenem antibiotics, typically reserved as a last line of defense against bacterial infections. 

The case report of a mid-50s Ukrainian soldier who suffered third-degree burns on 60 percent of his body due to a vehicle fire illustrates the threat posed by drug-resistant bacteria. The soldier received initial treatment in a facility near Dnipro, Ukraine, before being transferred to Kyiv and subsequently to a US military hospital in Germany. In Germany, healthcare providers screened the soldier’s samples for infections.

They discovered six distinct extensively drug-resistant (XDR) infections: A. baumannii, Enterococcus faecium, Klebsiella pneumoniae, and three variants of Pseudomonas aeruginosa. Each of these bacteria displayed resistance to multiple antibiotics. Notably, K. pneumoniae, a common nosocomial infection, was resistant to all tested antibiotics and carried 24 antimicrobial resistance genes and genetic markers associated with heightened virulence.

The A. baumannii isolates carried 18 antimicrobial resistance genes but remained susceptible to at least four antibiotics. The three P. aeruginosa strains were resistant to 20 out of 23 antibiotics tested, while the E. faecium isolate carried eight antimicrobial resistance genes and exhibited resistance to vancomycin, a critical last-line antibiotic. 

The case report’s authors, led by Patrick Mc Gann, emphasize the pressing need for healthcare practitioners treating Ukrainian citizens to be aware of the increased risk of transmitting and acquiring multi-drug resistant organisms due to the conflict in Ukraine. Implementing appropriate infection control measures is crucial to mitigate the spread of drug-resistant bacteria. The international community must rally to support Ukraine’s healthcare system by providing resources, expertise, and research to combat the rising tide of bacterial drug resistance.

Additionally, promoting responsible antibiotic use, investing in infection prevention and control, and advancing the development of new antimicrobial treatments are essential strategies to safeguard global public health from this escalating threat. We hope to address this alarming reality and prevent the further development of a global health crisis through concerted action and collaboration. 

The invasion of Ukraine by Russia has led to a dangerous rise in bacterial drug resistance, posing a significant threat to global public health. War conditions provide ideal circumstances for developing and spreading drug-resistant bacteria, and compromised healthcare systems exacerbate the situation further.

Urgent action is required to address this escalating crisis. By raising awareness, implementing infection control measures, and supporting Ukraine’s healthcare system, we can mitigate the spread of drug-resistant bacteria and protect the health of populations both within and beyond Ukraine’s borders.