Dangerous drug-resistant bacteria are spreading in Ukraine

When Pyotr Alexander Bezverhnyi was evacuated to the Feofania hospital in Kyiv, few believed that he would survive. The 27-year-old guy had a serious wound in his abdomen, his buttocks were pierced by shrapnel. Both his legs were amputated.

Then doctors discovered that his infections were resistant to commonly used antibiotics – and the already difficult task of saving his life became almost hopeless.

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

Ukraine is far from the only country affected by the problem, with an estimated 1.4 million people worldwide dying from AMR in 2021, and the UK having 66,730 serious antibiotic-resistant infections in 2023. However, the war seems to have accelerated the spread of multidrug-resistant pathogens in Ukraine.

A sharp increase in cases of AMR has been recorded in clinics treating war victims. More than 80% of all patients admitted to the Feofania hospital have infections caused by microbes resistant to antibiotics, said Deputy Chief Physician Dr. Andrei Strokan.

Ironically, antimicrobial-resistant infections often originate in healthcare settings.

Medical personnel try to follow strict hygiene protocols and use protective equipment to minimize the spread of these infections, but facilities can be overwhelmed by people injured during the war.

Dr. Uladzimir Dubina, head of the intensive care unit at Mechnikov Hospital, said that since the beginning of the Russian invasion, his unit alone has increased the number of beds from 16 to 50. Meanwhile, many employees have fled the war or joined the army themselves, and staffing levels are falling.

Dr. Strokan explained that these circumstances can affect the spread of AMR bacteria. “In surgical wards, one nurse serves 15-20 patients,” he said. “She is physically unable to wash her hands in the amount and frequency necessary to avoid spreading the 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 evacuated for medical reasons, he often passes through several facilities, each of which has its own strains of AMR. While health workers say this is inevitable due to the scale of the war, it only exacerbates the spread of AMR infections.

This was the case with Pte Byzverhny, who was treated in three different institutions before reaching the hospital in Kyiv. Because his infections could not be treated with conventional drugs, his condition worsened and he developed sepsis five times.

This situation differs from other recent conflicts, such as the war in Afghanistan, where Western soldiers were stabilized in place and then airlifted to a European clinic, rather than going through several different local facilities.

This would be impossible in Ukraine, as there has been no influx of patients since the Second World War, according to Dr. Dubina, whose hospital in Dnieper is located near the frontline regions. Once his patients are stable enough, they are transferred to another clinic – if there is room – to free up capacity.

“In terms of microbiological control, that means they spread (the bacteria) further. But if we don’t do that, we can’t work. Then it’s a disaster.”

With so many wounded, Ukrainian hospitals simply cannot afford to isolate infected patients – which means that resistant and dangerous bacteria are constantly spreading.

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

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

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

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