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Conflict zone medical evacuations catalyzing antimicrobial resistance spread and threatening regional health: A
Hailie D Uren1, Nataliia Aliieva, Nataliya Matolinets
1From the Unbroken Ukrainian Research Centre (H.D.U., N.A., N.M., B.H.B., J.B.H., O.V., H.H.), Lviv, Ukraine; First Lviv Territorial Medical Union (H.D.U., N.A., N.M., O.V., H.H.); Danylo Halytsky Lviv National Medical University (N.M.); Uniformed Services University of the Health Sciences (B.H.B., J.B.H.), University of Florida, Bethesda, Maryland; Department of Surgery (J.B.H.), University of Alabama, Birmingham, Alabama; Uniformed Services University for the Health Sciences (J.B.H.); Department of Surgery (H.H.), First Lviv Territorial Medical Union; Rehabilitation Centre 'Unbroken' (H.H.); and Department of General Surgery (H.H.), Danylo Halytsky Lviv National Medical University.
Background:
The interplay between armed conflict and antimicrobial resistance (AMR) poses significant public health challenges. In Ukraine, conflict-related factors such as medical evacuations, destruction of infrastructure, and displacement have exacerbated the spread of multidrug-resistant organisms, amplifying AMR risks within and beyond national borders.
Methods:
This retrospective comparative observational study was conducted at the First Lviv Territorial Medical Union, Western Ukraine's largest health care union. Clinically relevant diagnostic isolates were collected from May 2023 to April 2024. A local cumulative antibiogram from the First Lviv Territorial Medical Union was compared with those from Kyiv, Ukraine, and national surveillance reports from neighboring countries (Poland, Slovakia, Hungary, and Romania) to assess regional AMR variations.
Results:
Significant differences in AMR patterns were observed between Lviv and Kyiv, with Lviv exhibiting higher resistance rates in several pathogens, including higher rates of carbapenem resistance in Methicillin-resistant Staphylococcus Aureus (MRSA), carbapenem-resistant Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter species. The comparison with European surveillance data highlighted a higher prevalence of resistant phenotypes in Lviv, underscoring the high potential for cross-border spread of multidrug resistant organisms.
Conclusion:
The study highlights the critical impact of conflict on AMR spread in trauma patient evacuation pathways and emphasizes the need for robust local and regional AMR surveillance and control strategies. Enhanced antimicrobial stewardship and infection prevention and control measures are essential to mitigate the spread of AMR, particularly in conflict-affected areas like Ukraine. These data call for international collaboration to address the shared challenges of AMR in conflict settings.
Level Of Evidence:
Prognostic and Epidemiological; Level III.
Insights
Armed conflict in Ukraine has worsened antimicrobial resistance (AMR), with higher multidrug-resistant organism rates in Lviv compared to Kyiv. This highlights the need for enhanced surveillance and control strategies to combat AMR spread in conflict zones.
Area of Science:
- Infectious Diseases
- Public Health
- Epidemiology
Background:
- Armed conflict significantly exacerbates antimicrobial resistance (AMR) challenges.
- Conflict-related factors in Ukraine, including evacuations and infrastructure damage, have amplified the spread of multidrug-resistant organisms (MDROs).
- The risks of AMR extend beyond national borders, posing a global health security concern.
Purpose of the Study:
- To assess regional variations in AMR patterns within Ukraine.
- To compare local AMR data with national and neighboring countries' surveillance reports.
- To understand the impact of conflict on AMR in patient evacuation pathways.
Main Methods:
- Retrospective comparative observational study conducted at a major healthcare union in Western Ukraine.
- Analysis of clinically relevant diagnostic isolates from May 2023 to April 2024.
- Comparison of local antibiogram data with data from Kyiv, Ukraine, and surveillance reports from Poland, Slovakia, Hungary, and Romania.
Main Results:
- Significant differences in AMR patterns were observed between Lviv and Kyiv.
- Lviv showed higher resistance rates for key pathogens, including carbapenem resistance in Methicillin-resistant Staphylococcus Aureus (MRSA), Klebsiella pneumoniae, Escherichia coli, Pseudomonas aeruginosa, and Acinetobacter species.
- Higher prevalence of resistant phenotypes in Lviv compared to European data indicates a high potential for cross-border MDRO spread.
Conclusions:
- Conflict critically impacts AMR spread within trauma patient evacuation pathways.
- Robust local and regional AMR surveillance and control strategies are essential.
- Enhanced antimicrobial stewardship, infection prevention, and control measures are crucial in conflict-affected areas, necessitating international collaboration.
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