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The BBCWhen Pte Oleksandr Bezverkhny was evacuated to Feofania Hospital in Kyiv, few believed he would survive. The 27-year-old suffered severe abdominal trauma and shrapnel tore through his buttocks. Both his legs are amputated.
Doctors then discover that his infections are resistant to commonly used antibiotics – and the already difficult task of saving his life becomes almost hopeless.
Antimicrobial resistance (AMR) is when bacteria evolve and learn how to defend themselves against antibiotics and other drugs, making them ineffective.
Ukraine is far from the only country affected by this problem: an estimated 1.4 million people worldwide died from AMR infection 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 multidrug-resistant pathogens in Ukraine.
Clinics treating war wounded have seen a sharp increase in AMR cases. More than 80% of all patients admitted to Feofania Hospital have infections caused by microbes that are resistant to antibiotics, according to deputy chief physician Dr. Andrii Strokan.
Ironically, antimicrobial-resistant infections often originate in healthcare settings.
Medical personnel try to follow strict hygiene protocols and use protective equipment to minimize the spread of these infections, but facilities can be overwhelmed with people injured in the war.
Dr. Volodymyr Dubina, head of the intensive care unit at Mechnikov Hospital, said that since the beginning of the Russian invasion, his unit alone has increased the number of beds from 16 to 50. Meanwhile, with many staff fleeing the war or join the army, staff levels are down.
Dr. Strochan explained that these circumstances can affect the spread of AMR bacteria. “In the surgical wards, there is one nurse who looks after 15-20 patients,” he said. “She physically cannot wash her hands in the amount and frequency necessary to not spread infections.”
The nature of this war also means that patients are exposed to many more strains of infection than they would be in peacetime. When a soldier is medically evacuated, they often pass through multiple facilities, each with their own strains of AMR. While medical professionals say this is inevitable due to the scale of the war, it only worsens the spread of AMR infections.
This was the case for Pte Bezverkhny, who was treated in three different facilities before reaching the hospital in Kyiv. As his infections could not be treated with the usual drugs, his condition worsened and he contracted sepsis five times.
This situation is different from other recent conflicts, such as the war in Afghanistan, where Western soldiers would be stabilized on site and then airlifted to a European clinic, rather than going through multiple different local facilities.
This would not be possible in Ukraine, as the influx of patients has not been seen since World War II, according to Dr. Dubina, whose hospital in Dnipro is adjacent to frontline regions. Once his patients are stable enough, they are transferred to another clinic – if space is available – to free up capacity.
“In terms of microbiological control, that means they’re spreading (the bacteria) further.” But if this is not done, we are not able to work. Then it’s a disaster.”
With so many injured, Ukrainian hospitals usually can’t afford to isolate infected patients – meaning multi-resistant and dangerous bacteria are spreading 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 these antibiotics ineffective as well.
“We have to balance our scales,” explains Dr. Strokan. “On the one hand, we have to save a patient. On the other hand, we should not breed new microorganisms that will have antimicrobial resistance.”
In Pte Bezverkhny’s case, the doctors had to use very expensive antibiotics which the volunteers supplied from abroad. After a year in hospital and over 100 operations, his condition is now out of danger.
Doctors managed to save his life. But as pathogens become more resistant, the fight to save others becomes increasingly difficult.
