Surge in Drug-Resistant Infections Strains Ukraine’s War Clinics -

Pte Oleksander Bezverkhny, 27, was critically injured with severe abdominal wounds and shrapnel to his buttocks, leading to the amputation of both legs. Few believed he would survive when evacuated to Kyiv’s Feofaniya Hospital.

In Ukraine, the war has significantly worsened the situation of antimicrobial resistance (AMR), a global issue where bacteria evolve to resist commonly-used antibiotics. One of the most alarming cases is that of Pte Oleksander Bezverkhny, who, after sustaining severe abdominal injuries and losing both legs, was evacuated to Kyiv’s Feofaniya Hospital. Doctors discovered that his infections were resistant to antibiotics, complicating the already challenging task of saving his life.

AMR has become a critical concern worldwide, with approximately 1.4 million people dying from AMR-related infections in 2021. In the UK, there were over 66,000 serious antibiotic-resistant infections in 2023. However, the ongoing war in Ukraine has exacerbated the situation, accelerating the spread of multi-resistant pathogens.

Clinics in Ukraine, particularly those treating war injuries, have witnessed a sharp rise in AMR cases. According to Dr. Andriy Strokan, the deputy chief physician at Feofaniya Hospital, over 80% of patients admitted to the facility have infections caused by antibiotic-resistant microbes. Ironically, these infections often originate within medical settings. While healthcare staff work tirelessly to follow hygiene protocols and use protective gear, the overwhelming influx of war casualties strains their ability to contain the spread of infections.

Dr. Volodymyr Dubyna, head of the ICU at Mechnikov Hospital, highlighted the strain on resources, as the number of ICU beds has increased from 16 to 50 since the start of the Russian invasion. With many medical personnel either fleeing the war or joining the military, staffing levels have been severely impacted. Dr. Strokan further explained that these challenging circumstances have contributed to the spread of AMR bacteria, as understaffed surgical departments struggle to maintain proper hygiene standards, with nurses often responsible for caring for up to 15-20 patients at once. This insufficient care increases the risk of infection transmission.

As AMR infections continue to rise in Ukraine’s war clinics, the healthcare system faces an additional, often overlooked, challenge that threatens to worsen the already dire situation.

The nature of the ongoing war in Ukraine has exposed soldiers to an unprecedented level of risk regarding antimicrobial resistance (AMR) infections. Unlike in peacetime, where medical protocols can contain the spread of infection, soldiers in this conflict often pass through multiple medical facilities as they are evacuated for treatment. Each facility, with its own strains of AMR, adds to the risk of cross-contamination, worsening the spread of these resistant infections.

Pte Oleksander Bezverkhny’s case illustrates this issue. He was treated at three different facilities before finally reaching Feofaniya Hospital in Kyiv. His infections, resistant to standard antibiotics, caused his condition to deteriorate rapidly, leading him to contract sepsis five times. This complex path of treatment, involving multiple facilities, is a direct consequence of the war’s scale and logistics, and it greatly contributes to the spread of AMR infections.

In contrast, other recent conflicts, like the Afghanistan War, saw Western soldiers stabilized on-site and then airlifted directly to European clinics. This approach minimized exposure to different medical environments and helped contain the spread of infections. In Ukraine, however, the large number of casualties and the overwhelming burden on healthcare facilities makes it nearly impossible to avoid multiple points of care, intensifying the problem of AMR transmission.

The overwhelming influx of patients in Ukraine’s war-torn hospitals, a situation not seen since the Second World War, has strained the healthcare system to its breaking point. According to Dr. Volodymyr Dubyna, head of the ICU at a hospital in Dnipro, a city near the front lines, the sheer volume of wounded patients means that once stabilized, they are transferred to other clinics—if space is available—to free up capacity. However, this transfer of patients often exacerbates the spread of AMR bacteria as they pass through different facilities, increasing the risk of further contamination.

The medical teams face a harsh reality: hospitals simply cannot afford to isolate infected patients due to the overwhelming number of casualties. As a result, multi-resistant and dangerous bacteria spread unchecked, worsening the crisis. The infections caused by these resistant bacteria require treatment with special antibiotics from the “reserve” list. However, frequent use of these powerful antibiotics accelerates bacterial adaptation, rendering them ineffective over time.

Dr. Andriy Strokan, deputy chief physician at Feofaniya Hospital, describes the delicate balance doctors must maintain. “On one hand, we must save a patient. On the other, we mustn’t breed new microorganisms that will have antimicrobial resistance.” This dilemma highlights the difficult choices Ukrainian healthcare professionals face daily as they battle both the immediate threat of saving lives and the long-term consequences of fostering antimicrobial resistance.

In Pte Oleksander Bezverkhny’s case, doctors had no choice but to use expensive antibiotics, which were sourced from abroad by volunteers. After a year of intensive treatment and over 100 operations, his condition is no longer life-threatening, and he survived. However, his recovery is a rare success story in the face of escalating antimicrobial resistance (AMR).

Despite the doctors’ efforts, the spread of resistant pathogens continues to make it increasingly difficult to save others. As bacteria become more resistant to antibiotics, the medical community is confronted with the growing challenge of treating infections that were once manageable. The battle to save lives is becoming more complex and costly, and as AMR spreads, the window of opportunity for effective treatments continues to shrink.