Dangerous drug-resistant bacteria are spreading in Ukraine
BBCWhen PTE Oleksandr Bezverkhny was taken to Kiev’s Feofaniya Hospital, few people believed he would survive. The 27-year-old was seriously injured in the stomach and shrapnel had penetrated his buttocks. Both his legs were amputated.
Then, doctors discovered that his infection was resistant to commonly used antibiotics – and the already difficult task of saving his life became almost hopeless.
Antimicrobial resistance (AMR) occurs 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 issue: Nearly 1.4 million people died from AMR infections globally in 2021, and there were 66,730 serious antibiotic-resistant infections in the UK in 2023. However, the war appears to have accelerated the spread of the multi-resistant pathogen in Ukraine.
Clinics treating war injuries have reported a sharp increase in AMR cases. According to Deputy Chief Physician Dr. Andrey Strokan, more than 80% of all patients admitted to Feofania hospital have infections caused by germs that are resistant to antibiotics.
Ironically, antimicrobial-resistant infections often originate from medical facilities.
Medical staff attempt to follow strict hygiene protocols and use protective equipment to reduce the spread of these infections, but facilities can be overwhelmed by war-wounded people.
Dr. Volodymyr Dubina, head of the Mechnikov hospital’s ICU, said his unit alone had increased the number of beds from 16 to 50 since the beginning of the Russian invasion. Meanwhile, many workers fled the war or joined the army themselves. Levels are down.
Dr. Strocken explained that these conditions can affect the spread of AMR bacteria. “There is one nurse in the surgical department who takes care of 15-20 patients,” he said. “She cannot physically clean her hands in the amount and frequency necessary to not spread the infection.”
The nature of war also means that patients are exposed to many more types of infections than in peacetime. When a soldier is evacuated for medical reasons, they often go through multiple facilities, each of which has its own strain of AMR. While medical professionals say this is inevitable due to the scale of the war, it only increases the spread of AMR infections.
This was the case of PTE Bezverkhny, who was treated in three different facilities before reaching hospital in Kiev. Because his infection could not be treated with normal medicine, his condition worsened and he developed sepsis five times.
This situation differs from other recent conflicts, for example the Afghanistan War, where Western troops would be stabilized on site and then transferred by air to a European clinic, rather than passing through several different local facilities.
This would not be possible in Ukraine because of an influx of patients not seen since World War II, according to Dr. Dubina, whose hospital in Dnipro neighboring border areas. Once her patients are stable enough, they are transferred to another clinic to free up capacity – if there is space.
“In terms of microbiological control, it means they (bacteria) spread more. But if that’s not done, we’re not able to do the job. Then it’s a disaster.”
With so many injured, Ukrainian hospitals typically cannot afford to isolate infected patients – meaning 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 them, the faster the bacteria adapt, making even those antibiotics ineffective.
“We have to balance our scales,” Dr. Strocken explains. “On the one hand, we must save a patient. On the other – we must not breed new microorganisms that have antimicrobial resistance.”
In the case of PTE Bezverkhny, doctors had to use very expensive antibiotics, which volunteers ordered from abroad. After a year in hospital and more than 100 operations, his condition is no longer life-threatening.
The doctors were successful in saving his life. But as pathogens become more resistant, the struggle to protect others becomes more difficult.
