War clinics in Ukraine witness sharp rise in drug-resistant infections

In Ukraine, the ongoing war has led to a significant increase in drug-resistant infections among soldiers receiving medical treatment. One such soldier, Pte Oleksander Bezverkhny, faced a life-threatening situation after suffering severe injuries, including the loss of both legs. When he was brought to the Feofaniya Hospital in Kyiv, the medical team was deeply concerned about his chances of survival. He had a critical abdominal injury, and shrapnel had caused extensive damage. Unfortunately, doctors soon discovered that the infections he had contracted were resistant to standard antibiotics, complicating their efforts to save his life. Antimicrobial resistance, or AMR, occurs when bacteria evolve and become immune to the effects of antibiotics and other medications, rendering them ineffective. This issue is not unique to Ukraine; it is a global concern. In 2021, approximately 1. 4 million people worldwide died from AMR infections, and in the UK alone, there were over 66,730 serious cases reported in 2023. The war in Ukraine has exacerbated the situation, with hospitals treating war injuries experiencing a sharp rise in AMR cases. According to Dr Andriy Strokan, the deputy chief physician at Feofaniya Hospital, more than 80% of patients admitted to the facility are suffering from infections caused by antibiotic-resistant microbes. Ironically, many of these infections originate in medical settings. Despite the medical staff's best efforts to adhere to strict hygiene protocols and utilize protective equipment, the overwhelming number of injured individuals has made it increasingly difficult to control the spread of these infections. Dr Volodymyr Dubyna, who heads the intensive care unit at Mechnikov Hospital, noted that since the onset of the Russian invasion, his unit has expanded its capacity from 16 to 50 beds. Compounding the problem, many healthcare workers have either fled the country or joined the military, resulting in a significant reduction in staffing levels. Dr Strokan explained that these circumstances contribute to the spread of AMR bacteria. He stated, 'In surgical departments, there is one nurse responsible for 15 to 20 patients. She simply cannot wash her hands as frequently as necessary to prevent the transmission of infections. ' The nature of the conflict also exposes patients to a wider variety of infection strains than they would encounter in peacetime. When a soldier is evacuated for medical treatment, they often pass through multiple facilities, each harboring its own strains of AMR. While medical professionals acknowledge that this is an unavoidable consequence of the war's scale, it only serves to exacerbate the spread of AMR infections. This was the case for Pte Bezverkhny, who was treated at three different medical facilities before arriving at the hospital in Kyiv. Due to the ineffectiveness of standard medications, his condition worsened, and he experienced sepsis on five separate occasions. This situation differs from other recent conflicts, such as the Afghanistan War, where Western soldiers would typically be stabilized on-site and then airlifted to a European hospital, avoiding multiple local facilities. In Ukraine, the influx of patients has reached levels not seen since World War II, according to Dr Dubyna, whose hospital is located near the front lines. Once patients are stable enough, they are transferred to other clinics if space is available, in order to free up capacity. Dr Dubyna explained, 'In terms of microbiological control, this means that bacteria are spread further. But if we do not transfer patients, we cannot continue to operate. Then it becomes a catastrophe. ' With so many wounded individuals, Ukrainian hospitals often lack the resources to isolate infected patients, allowing multi-resistant and dangerous bacteria to spread unchecked. The infections caused by these bacteria require treatment with special antibiotics from a reserve list. However, the more frequently these antibiotics are prescribed, the quicker the bacteria adapt, rendering them ineffective as well. Dr Strokan elaborated, 'We must find a balance. On one hand, we need to save a patient. On the other hand, we must not create new microorganisms that will develop antimicrobial resistance. ' In Pte Bezverkhny's case, doctors had to resort to using very expensive antibiotics that were sourced from abroad by volunteers. After spending a year in the hospital and undergoing over 100 operations, his condition is no longer life-threatening. The medical team was able to save his life, but as pathogens continue to grow more resistant, the challenge of saving others becomes increasingly difficult.