Scientists are sounding the alarm: Extremely resistant bacteria are spreading in Ukraine’s clinics. Many patients injured in war carry pathogens that are immune to even emergency antibiotics, as samples have shown. Six percent of the germs tested were even resistant to all known antibiotics. The researchers report that such a degree of antibiotic resistance has never been encountered before, not even in India and China.
More and more bacterial pathogens are immune to common antibiotics. They have developed defense mechanisms against the antibiotic mechanisms of action through mutations and then pass on the corresponding resistance genes to bacteria of other species and groups. As a result, many pathogens are now immune to emergency antibiotics such as colistin and new active ingredients. As a result, in 2019 alone, more people died from actually curable infections than from HIV or malaria.
Call for help from Ukraine
Now a study reveals that Ukraine has also developed into a hotspot of antibiotic resistance. There had been increased resistance in military hospitals since the annexation of Crimea in 2014, and the situation worsened with the start of the war in February 2022. The Ukrainian microbiologist Oleksandr Nazarchuk from the University of Vinnytsia therefore asked Swedish colleagues for support in assessing the resistance situation.
Between February and September 2022, a research team led by Kristian Riesbeck from Lund University made several trips to Ukraine and collected samples from a total of 141 patients in three hospitals. These included 133 seriously injured soldiers and civilians with war-related bullet wounds, burns or broken bones and eight children with pneumonia. All patients were suspected of suffering from bacterial infections.
Unprecedented level of resistance
The evaluation of the samples revealed an alarmingly large number of multi-resistant pathogens: “Several of the gram-negative bacteria showed resistance to broad-spectrum antibiotics, including newly developed enzyme-inhibiting agents that are not yet available on the market,” reports Riesbeck. The antibiotics affected include the combination of active ingredients ceftazidime-avibatam, which is used specifically against bacteria that are already otherwise resistant. 80 percent of the pathogens isolated in the Ukrainian clinics were immune to this agent.
The researchers also found resistance to the reserve antibiotic cefiderocol, which was only approved in the EU in 2020, and the likewise new active ingredient combination ceftolozane-tazobactam. “In addition, almost ten percent of the samples were resistant to our reserve antibiotic colistin, which is only administered in the greatest emergency,” says Riesbeck. “Up to six percent of the samples contained bacteria that were immune to each antibiotic tested.”
This level of bacterial resistance is alarming: “I’ve gotten used to it and have examined many patients and bacteria. But I have to admit that I’ve never encountered such resistant bacteria before,” says Riesbeck. “Even in India and China, where we have already found many multidrug-resistant pathogens, we have not found anything comparable with this level of resistance.”
Extreme resistance even with the “super germ” Klebsiella
The samples of the pathogen Klebsiella pneumoniae isolated in Ukraine showed a particularly broad spectrum of resistance. This bacterium is listed by the World Health Organization as one of the most dangerous multi-resistant pathogens. Infections with this pathogen can be fatal, especially for immunocompromised people and hospital patients. But Klebsiella pneumoniae can also cause pneumonia and urinary tract infections in healthy people.
The Ukrainian Klebsiella isolates were 81 to 100 percent resistant to five of the six antibiotics tested, and 24 percent also showed colistin resistance. “This worries me a lot because it’s very rare to find Klebsiella strains with such a high level of resistance. We didn’t expect anything like that,” says Riesbeck. “Although individual cases have also been documented in China, the scale of the situation here surpasses anything seen before.”
war on two fronts
According to the research team, these results underline that the war in Ukraine also has serious medical consequences. “The healthcare system in Ukraine is under immense pressure. The limited resources make it very difficult to maintain the prevention and control of infection,” the scientists state. “This favors the spread of resistant pathogens.”
That is why it is now essential to also provide medical aid to Ukraine. “We have to help them monitor this situation and get it under control,” says Riesbeck. “Otherwise there is a risk of further spread of these resistant bacteria and that is a threat to the entire European region.” (The Lancet Infectious Diseases, 2023; doi: 10.1016/S1473-3099(23)00291-8)
Source: Lund University