Wartime spread of drug-resistant infections in Ukraine is an ‘urgent crisis,’ CDC report says

By Jacqueline Howard, CNN

(CNN) — Hospitals and health facilities in Ukraine are facing an “alarming increase” of antimicrobial-resistant infections amid the war with Russia, a new report says.

The spread of antimicrobial resistance – which occurs when bacteria, viruses, fungi and parasites no longer respond to medications that treat them – is an “urgent crisis” in Ukraine that “must be addressed,” according to the report, published Friday by the US Centers for Disease Control and Prevention.

“Worldwide, bacterial antimicrobial resistance is estimated to cause more deaths than HIV or malaria and is recognized as a leading global public health threat,” wrote the researchers, who are from the CDC, the Center for Public Health of Ukraine, the World Health Organization and other institutions.

WHO refers to antimicrobial resistance as “one of the top global public health and development threats,” and it is estimated that bacterial antimicrobial resistance was responsible for more than 1 million deaths around the world in 2019. Among the main drivers of drug-resistant pathogens are the misuse and overuse of antimicrobial drugs in humans and agriculture.

“In Ukraine, the confluence of high prewar rates of antimicrobial resistance, an increase in the prevalence of traumatic wounds, and the war-related strain on health care facilities is leading to increased detection of multidrug-resistant organisms with spread into Europe,” the researchers wrote. “Evidence of increased rates of antimicrobial resistance in other conflict settings such as Iraq, and the long-term consequences for civilian, military, and other populations, argue that the spread of antimicrobial resistance in Ukraine is an urgent crisis that must be addressed, even during an ongoing war.”

Researchers at the Center for Public Health of Ukraine – also known as the UPHC – conducted surveys at three regional hospitals in November and December 2022. Of 353 patients surveyed, the researchers found that 50 of them, or 14%, had infections associated with their health care stay, and “high rates of antimicrobial resistance” were identified. Among those patients with health care-associated infections, 30 of them or 60% were infected with an organism resistant to the broad-spectrum antibiotic carbapenem.

The researchers noted that is much higher than the rates of antimicrobial resistance that were reported in a 2016-17 survey of more than 300,000 hospital patients and 100,000 long-term care facility residents across the European Union, where 6.2% of similar types of infections were resistant to carbapenem.

A separate report published by the CDC in August said that six drug-resistant bacteria had been found in one injured soldier in Ukraine. The man, in his mid-50s, had traumatic injuries and burns from a vehicle fire. He was initially treated in a medical facility near Dnipro, Uktaine, before being transferred to a hospital in Kyiv and then to a US military hospital in Germany, where surveillance cultures were collected and later used to identify the bacteria.

According to the new report, in August 2022, the Center for Public Health of Ukraine and researchers in the region conducted assessments of infection prevention and control and antimicrobial resistance lab capacity in three regional public health health facilities and three regional hospitals in Ternopil, Khmelnytskyi and Vinnytsia.

Those assessments found “inadequacies” in the surveillance of infections and the implementation of prevention measures, such as hand hygiene. The lab assessments identified “multiple challenges,” including having “inadequate” quantities of certain equipment and “suboptimal” biosafety practices, as well as the “inconsistent availability” of antibiotic susceptibility testing consumables.

“Urgent capacity building to prevent, detect, and respond to antimicrobial resistance is needed to save lives within Ukraine and limit international spread. UPHC and partners are collaborating to improve laboratory detection of antimicrobial resistance, antimicrobial prescribing, and infection prevention and control, starting in the Ternopil, Khmelnytskyi, and Vinnytsia regions,” the researchers wrote in the new report.

For instance, in August, the WHO Country Office in Ukraine donated antimicrobial resistance surveillance equipment and consumables to 10 laboratories across the country and consumables alone to 11 more labs that already had equipment.

“To address the alarming increase of antimicrobial resistance in Ukraine, UPHC with assistance from international partners, is developing locally led and implemented measures to address antimicrobial resistance and will need ongoing support to scale them nationally,” the researchers wrote. “In addition, development of national action plans and context-specific policies and strategies are needed to improve infection prevention and control and monitor antibiotic use and antimicrobial resistance.”

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