Dangerous drug-resistant bacteria are spreading in Ukraine

When soldier Oleksander Bezverkhny was evacuated to kyiv’s Feofaniya hospital, few believed he would live. The 27-year-old had a serious abdominal injury and shrapnel had torn his buttocks. Both his legs were amputated.

Doctors then discovered that his infections were resistant to commonly used antibiotics, and the already daunting task of saving his life became nearly impossible.

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

Ukraine is far from the only country affected by this problem: around 1.4 million people worldwide died from an AMR infection in 2021, and in the UK there were 66,730 serious antibiotic-resistant infections in 2023. However, the war appears to have accelerated the spread of the disease. Multiresistant pathogens in Ukraine.

Clinics treating war wounds have recorded a sharp increase in AMR cases. According to Deputy Chief Physician Dr. Andriy Strokan, more than 80% of all patients admitted to the Feofaniya hospital suffer from infections caused by antibiotic-resistant microbes.

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

Medical staff attempt to follow strict hygiene protocols and use protective equipment to minimize the spread of these infections, but facilities can become overwhelmed with people injured in war.

Dr. Volodymyr Dubyna, head of Mechnikov Hospital’s ICU, said that since the start of the Russian invasion his unit has increased the number of beds from 16 to 50. Meanwhile, as many employees flee the war or join the army, staffing levels are low.

Dr. Strokan explained that these circumstances can affect the spread of AMR bacteria. “In the surgical departments there is one nurse who cares for between 15 and 20 patients,” he said. “You physically cannot wash your hands as much and frequently as necessary to not spread infection.”

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

This was the case of Pte Bezverkhny, who was treated in three different centers before arriving at the kyiv hospital. As his infections could not be treated with regular medication, his condition worsened and he contracted sepsis five times.

This situation is unlike other recent conflicts, for example the war in Afghanistan, where Western soldiers would be stabilized on site and then flown to a European clinic rather than passing through multiple different local facilities.

This would not be possible in Ukraine, as it has not seen an influx of patients since World War II, according to Dr. Dubyna, whose hospital in Dnipro is close to frontline regions. Once their patients are stable enough, they are moved to another clinic – if it has space – to free up capacity.

“In terms of microbiological control, it means that the bacteria spread even more. But if it is not done, we will not be able to work. Then it will be a catastrophe.”

With so many injured, Ukrainian hospitals typically cannot afford to isolate infected patients, meaning dangerous, multi-resistant bacteria spread uncontrollably.

The problem is that the infections they cause must be treated with special antibiotics from the “reserve” list. But the more doctors prescribe them, the faster the bacteria adapt, making those antibiotics ineffective as well.

“We have to balance our scales,” explains Dr. Strokan. “On the one hand, we must save the patient. On the other, we must not generate new microorganisms that have resistance to antimicrobials.”

In the case of Pte Bezverkhny, doctors had to use very expensive antibiotics, which the volunteers purchased abroad. After a year in the hospital and more than 100 operations, his condition is no longer life-threatening.

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