The Urgent Crisis of Drug-Resistant Infections During Wartime in Ukraine

Ukraine's hospitals and health facilities are experiencing a concerning rise in antimicrobial-resistant infections due to the ongoing conflict with Russia, according to a new report. The spread of antimicrobial resistance, where bacteria, viruses, fungi, and parasites no longer respond to medications, is deemed an urgent crisis in Ukraine that requires immediate attention, as per the report released by the US Centers for Disease Control and Prevention on Friday.

On Wednesday, June 7, 2023, pedestrians at Washington Square Park in New York, US, were enveloped in smoke from wildfires in Canada. The smoke, which is expected to linger for the next few days, has raised health concerns in the US Northeast, including New York City. The image was captured by photographer Alex Kent/Bloomberg via Getty Images.

Alex Kent/Bloomberg/Getty Images

Air pollution may contribute to rising threat of antimicrobial resistance, study says

Researchers from the CDC, the Center for Public Health of Ukraine, the World Health Organization, and other institutions have highlighted the alarming impact of bacterial antimicrobial resistance. They estimate that it causes more deaths worldwide than HIV or malaria, making it a major global public health threat. The World Health Organization has labeled antimicrobial resistance as one of the top global public health and development threats, attributing over 1 million deaths to bacterial antimicrobial resistance in 2019. The misuse and overuse of antimicrobial drugs in humans and agriculture are identified as main drivers of drug-resistant pathogens.

The surge in antimicrobial resistance rates and prevalence of traumatic wounds, combined with the strain on healthcare facilities due to the war, has caused an increase in multidrug-resistant organisms detected in Ukraine, with potential spread into Europe according to the researchers. Evidence from conflict settings like Iraq suggests that the spread in Ukraine is a pressing crisis, necessitating immediate attention.

A survey conducted by the UPHC in November-December 2022 at three regional hospitals found that 14% of patients had infections related to their healthcare stay, with a significant number exhibiting high levels of antimicrobial resistance. Additionally, among those with healthcare-associated infections, 60% were infected with carbapenem-resistant organisms.

The researchers observed a significantly higher rate of antimicrobial resistance compared to the rates reported in a 2016-17 survey of over 300,000 hospital patients and 100,000 long-term care facility residents across the European Union. In that study, 6.2% of similar types of infections were resistant to carbapenem.

video

Behind a unique approach to treat antibiotic resistant superbugs

In August, a CDC report revealed that a single soldier in Ukraine had tested positive for six drug-resistant bacteria. The man, in his mid-50s, sustained traumatic injuries and burns from a vehicle fire and was initially treated in a medical facility near Dnipro. He was later transferred to a hospital in Kyiv and then to a US military hospital in Germany, where surveillance cultures were collected and used to identify the bacteria.

The new report states that the Center for Public Health of Ukraine, along with regional researchers, conducted assessments of infection prevention and control as well as antimicrobial resistance lab capacity in three regional public health facilities and three regional hospitals in Ternopil, Khmelnytskyi, and Vinnytsia in August 2022.

Sign up for CNN Health's weekly newsletter for the latest on health news, research, and updates.

Join us to receive The Results Are In with Dr. Sanjay Gupta every Tuesday from the CNN Health team. Ukraine requires immediate capacity building to prevent, detect, and respond to antimicrobial resistance in order to save lives and prevent international spread. UPHC and its partners are working together to enhance laboratory detection of antimicrobial resistance, improve antimicrobial prescribing, and enhance infection prevention and control in the Ternopil, Khmelnytskyi, and Vinnytsia regions, as outlined in the new report by researchers.

In August, the WHO Country Office in Ukraine provided antimicrobial resistance surveillance equipment and consumables to 10 laboratories throughout the country. They also supplied consumables to an additional 11 labs that already had equipment. The researchers emphasized the urgent need to address the increasing antimicrobial resistance in Ukraine by developing locally led measures, calling for ongoing support to implement these measures nationwide. They also highlighted the necessity of national action plans, context-specific policies, and strategies to enhance infection prevention and control and to monitor antibiotic use and antimicrobial resistance.