BBCWhen Pte Oleksander Bezverkhny was evacuated to Kiev’s Feofaniya Hospital, few believed he would live. The 27-year-old suffered serious abdominal injuries and shrapnel penetrated his hip. Both of his legs were amputated.
Then doctors discovered that his infection was resistant to commonly used antibiotics, making the already difficult task of saving his life almost hopeless.
Antimicrobial resistance (AMR) is when bacteria evolve and learn ways to defend themselves against antibiotics and other medicines, rendering them ineffective.
Ukraine is not the only country affected by this problem. An estimated 1.4 million people worldwide will die from AMR infections in 2021, and in the UK, 66,730 people will develop serious antibiotic-resistant infections in 2023. However, the war appears to have accelerated the spread of AMR infections. Multiresistant pathogens in Ukraine.
Clinics treating war injuries have seen a sharp rise in AMR cases. More than 80% of all patients admitted to Feofaniya Hospital suffer from infections caused by microorganisms resistant to antibiotics, deputy chief physician Dr. Andriy Strokan said.
Ironically, antibiotic-resistant infections often occur in healthcare settings.
Although medical staff try to minimize the spread of these infections by following strict hygiene protocols and using protective equipment, facilities can be overcrowded with people injured in war.
Dr. Volodymyr Dubyna, head of the intensive care unit at Metchnikov Hospital, said the number of beds in his unit alone had increased from 16 to 50 since the Russian invasion began. Meanwhile, levels fell as many employees left for war or joined the military directly.
Dr. Strokan explained that these circumstances may contribute to the spread of AMR bacteria. “There is one nurse in the surgery department who looks after 15 to 20 patients,” he said. “She is physically unable to clean her hands in the amount and frequency necessary to avoid spreading the infection.”
The nature of this war means that patients are exposed to far more types of infections than in peacetime. When soldiers evacuate for medical reasons, they often pass through multiple facilities, each with its own AMR strain. Medical experts say the scale of the war makes it inevitable, but this will only worsen the spread of AMR infections.
This was the case for Pte Bezverkhny, who was treated in three different facilities before arriving at the hospital in Kiev. Since it was impossible to treat with regular medications, the condition worsened and sepsis developed five times.
This situation differs from other recent conflicts, such as the war in Afghanistan, where Western soldiers are stabilized in the field and then airlifted to European hospitals rather than through multiple regional facilities.
According to Dr. Dubyna, whose hospital in Dnipro is adjacent to a front-line area, this would not be possible in Ukraine as the country has not seen an influx of patients since World War II. Once the patient is sufficiently stable, we move them to another clinic if space is available to ensure capacity.
“If you look at microbiological control, it means spreading (bacteria) further. But if that doesn’t work, you can’t work. That would be a disaster.”
Because there are so many injured, Ukrainian hospitals generally cannot afford to isolate infected patients. This means that dangerous multi-resistant bacteria can spread unchecked.
The problem is that the infections they cause must be treated with special antibiotics from the “backup” list. But the more often your doctor prescribes these medications, the faster the bacteria will adapt and those antibiotics will become ineffective as well.
“You have to balance the scales,” explains Dr. Strokan. “On the one hand, we must save patients. On the other hand, we must not breed new microorganisms that will become resistant to antimicrobial agents.”
In the case of Pte Bezverkhny, doctors had to use very expensive antibiotics sourced from abroad by volunteers. After a year in hospital and more than 100 surgeries, his condition is no longer life-threatening.
Doctors saved his life. But as pathogens become more resistant, the fight to save others only becomes more difficult.
