The war in Ukraine is fueling antimicrobial resistance

The war in Ukraine is increasing the spread of antimicrobial resistance, said Dr. Laura Jung, a clinician and researcher on antibiotic resistance at the University of Leipzig Medical Center in Germany, during the World Health Summit on Tuesday.

"Right now in the hospital, the most resistant infections that we are seeing are people that come from Ukraine that got wounded in battles, treated in field hospitals, and then at some point made it to Germany or to central Europe,” she said. “And it's very devastating and very concerning as a clinician when you get back those lab results. … You end up very empty-handed in front of your patients.”

Antimicrobial resistance was estimated to be directly responsible for 1.27 million deaths globally in 2019, and was associated with an estimated 4.95 million deaths.  

Dr. Muhammad Asaduzzaman, doctoral research fellow at the department of community medicine and global health at the University of Oslo, wrote about the link between the war in Ukraine and antimicrobial resistance in June.

Infection prevention and microbiological diagnosis, which help ensure patients receive the right antibiotics, are often not available in war zones, he wrote. And environmental contamination fuels the spread.

“The environments in conflict zones are heavily contaminated with explosive metabolites such as polycyclic aromatic hydrocarbons (PAHs) and heavy metals, which are drained into groundwater sources and mixed with soil, inducing multidrug bacterial resistance,” he said, adding that multidrug resistance is driven by “co- or cross-resistance through horizontal gene transfer between bacterial species or mutations, even at sub-lethal doses of metals.”

Asaduzzaman also wrote that this was a problem in the wars in Afghanistan and Iraq.

Dr. Richard Armitage, a general practitioner who has provided primary health care to internally displaced people in Ukraine, also wrote in June that “urgent public health messages must be communicated to frontline clinicians and Ukrainian citizens to positively influence health behaviour and promote the safe, appropriate and sustainable use of antimicrobials.”

The European Centre for Disease Prevention and Control wrote in March that those with traumatic wounds in Ukraine may be harboring multidrug-resistant A. baumannii and K. pneumoniae, among other multidrug-resistant organisms. “Patients transferred from hospitals in Ukraine, or with a history of hospital admission in Ukraine in the last 12 months should be isolated pre-emptively and screened for carriage of multidrug-resistant organisms,” the institution wrote.  

Despite growing inefficiencies of antibiotics, the pipeline for bringing new antibiotics to market is stagnant and lacks innovation, Jung said, adding that it's frustrating for clinicians working in antimicrobial resistance when they compare themselves with colleagues in cardiology or oncology who have access to new drugs that enter the market each year.

“You can also imagine that if that is my situation here in a German tertiary care center, it's even worse in many parts of the world,” she said.

And while the impact of the war in Ukraine is relevant to Europe, antimicrobial resistance spreads rapidly beyond borders.

“Nobody's safe until everybody is safe,” said Dr. Martin Fitchet, global head of global public health at Johnson & Johnson during the summit.