Dangerous drug-resistant bacteria are spreading in Ukraine

When Oleksander Bezverkhny was evacuated to Feofaniya Hospital in Kiev, few thought he would live. The 27-year-old had a serious wound to his abdomen and shrapnel tore his butt. Both legs were amputated.

Doctors then discovered that her infections were resistant to commonly used antibiotics, making the daunting task of saving her life almost hopeless.

Antimicrobial resistance (AMR) is when bacteria evolve and learn how to defend themselves against antibiotics and other drugs, rendering them ineffective.

Ukraine is far from the only country affected by this issue: around 1.4 million people worldwide died from an AMR infection in 2021, and in the UK in 2023 there were 66,730 serious infections resistant to antibiotics. However, the war seems to have accelerated the expansion. multi-resistant pathogens in Ukraine.

Clinics treating war injuries have recorded a large increase in AMR cases. More than 80% of all patients admitted to Feofaniya Hospital have infections caused by microbes resistant to antibiotics, says deputy doctor Andriy Strokan.

Ironically, antimicrobial-resistant infections often originate from medical facilities.

Medical staff try to follow strict hygiene protocols and use protective equipment to minimize the spread of these infections, but facilities can become overrun with war-wounded people.

Dr. Volodymyr Dubyna, head of the ICU at Mechnikov Hospital, said that his unit alone has increased the number of beds from 16 to 50 since the Russian invasion began. Meanwhile, as many workers fled the war or joined the military, they were working. levels have dropped.

Dr. Strokan explained that these circumstances can affect the spread of AMR bacteria. “There is one nurse who takes care of 15-20 patients in the surgical wards,” he said. “He is physically unable to wash his hands to the extent and frequency necessary to prevent the spread of infection.”

The nature of this war also means that patients are exposed to many more strains of infection than in peacetime. When a soldier is evacuated for medical reasons, they will often pass through multiple facilities, each with their own strain of AMR. Although medical professionals say this is inevitable due to the scale of the war, the spread of AMR infections worsens it.

This was the case for Bezverkhny Pte who was treated in three different facilities before arriving at the hospital in Kiev. As her infections could not be treated with conventional medication, her condition worsened and she contracted sepsis five times.

This situation is different from other recent conflicts, such as the Afghanistan War, where Western soldiers would be stabilized locally and then airlifted to the European clinic, rather than going through several different local facilities.

This would not be possible in Ukraine, which has not seen an influx of patients since World War II, according to Dr. Dubyna, whose hospital in Dnipro is located in the frontline regions. When his patients are stable enough, he moves them to another clinic – if there is room – to free up capacity.

“In terms of microbiological control, it means that (bacteria) spread more. But if it’s not done, we’re not able to work. Then it’s a disaster.”

With so many injured, Ukrainian hospitals are usually unable to isolate infected patients; that is, multi-resistant and dangerous bacteria spread unchecked.

The problem is that the infections they cause must be treated with special antibiotics from the “reserve” list. But the more often doctors prescribe, the faster the bacteria adapt, and even these antibiotics are ineffective.

“We have to balance our scales,” explained Dr. Strokan. “On the one hand, we have to save a patient. On the other hand, we don’t have to grow new microorganisms that will be resistant to microbes.”

In Pte Bezverkhny’s case, doctors had to use very expensive antibiotics, which were sourced by volunteers from abroad. After a year in the hospital and more than 100 operations, his condition is not life-threatening.

Doctors managed to save his life. But as pathogens become more resistant, the fight to save others becomes more difficult.