The price of WAR: AMR

Area of Science:

• Infectious Diseases
• Genomics
• Antimicrobial Resistance

Background:

• The Ukraine conflict increases multidrug-resistant (MDR) bacterial infection risks in war-injured patients.
• Traumatic injuries from conflict create opportunities for severe bacterial colonization and infection.

Purpose of the Study:

• To report the successful management of a war-injured soldier with a carbapenem-resistant Klebsiella pneumoniae infection.
• To characterize the infecting strain using whole-genome sequencing (WGS) and identify resistance mechanisms.
• To evaluate the efficacy of specific antibiotic regimens.

Main Methods:

• Case report of a Ukrainian soldier with a traumatic lower extremity injury and subsequent MDR infection.
• Isolation and identification of carbapenem-resistant Klebsiella pneumoniae from surgical wound cultures.
• Whole-genome sequencing (WGS) of the Klebsiella pneumoniae isolate to determine its strain, virulence factors, and resistance genes (including blaNDM-1).
• Clinical management and treatment response assessment.

Main Results:

• Successful treatment of a traumatic injury complicated by carbapenem-resistant Klebsiella pneumoniae infection.
• WGS identified the isolate as a hypervirulent ST147 strain possessing multiple resistance and virulence factors, including the blaNDM-1 gene.
• The patient responded effectively to treatment with ceftazidime/avibactam and aztreonam.

Conclusions:

• Ceftazidime/avibactam and aztreonam represent a promising therapeutic option for managing multidrug-resistant infections in the context of armed conflict.
• Genomic surveillance is crucial for understanding and combating the spread of resistant pathogens in war zones.
• This case highlights the challenges and successful strategies for treating severe infections in patients injured during conflict.