Drug-resistant superbugs: another enemy of Ukraine during the war

Severely wounded Ukrainian soldier Anton Sushko thought he was finally safe when he spotted a rescue team after hours of crawling across a battlefield in eastern Ukraine.

“That’s it, I thought, here you go guys… We did it. Wounded, but alive,” the 40-year-old man recalled from his hospital bed in Dnieper in southeastern Ukraine.

But Sushko was not yet out of danger.

By the time he escaped, a wound on his left leg had become infected with aggressive bacteria that was resistant to antibiotics, making it more difficult for doctors to treat him.

Thousands of other soldiers, like him, returned from the front with wounds festering with multidrug-resistant microorganisms, pointing to the little-understood cost of war.

Bacteria have long developed resistance to the drugs designed to fight them, rendering many drugs useless.

The process known as antimicrobial resistance (AMR) directly causes more than a million deaths and contributes to five million deaths each year, according to the World Health Organization.

This was facilitated by the massive use of antibiotics to treat people, animals and food products, including in Ukraine.

However, during the Russian invasion, Ukraine has seen a particular increase in antimicrobial resistance, according to WHO representative in Ukraine Jarno Habicht.

“The main reason for the rise in antimicrobial resistance is actually the ongoing war,” he said.

– ‘Dirty, rotting’ –

Direct combat and air strikes led to an increase in the number of trauma patients that overwhelmed understaffed hospitals.

At the Dnepropetrovsk Mechnikov Hospital, where soldier Sushko was treated, the workload has increased tenfold, said chief surgeon Sergei Kosulnikov.

“Every blast wave is an open wound, and every open wound is an infection,” Kosulnikov said, showing AFP slides of purulent lesions.

Blast injuries on the battlefield are rarely treated in time as evacuating drone-infested front lines becomes increasingly dangerous.

By the time medical teams examine them, the wounds are often “dirty, rotting, with necrotic (dead) tissue and bone, and full of aggressive microbes that are difficult to fight,” Kosulnikov said.

To save the lives of their patients, teams often have no choice but to prescribe strong antibiotics.

And they rarely have time to wait for lab results to determine the right antibiotics to use.

“It’s impossible to imagine all this without growing resistance,” Kosulnikov said.

“The more we try to somehow kill the microbe, the more it defends itself.”

This process forces doctors to seek even stronger antibiotics to save the lives of patients who can do nothing but hope the medicine will work.

– ‘Not in vain’ –

While waiting, Sushko tried to find meaning in all this.

“I distract myself with music, read literature in order to penetrate deeper into the roots of our people, so that the soul understands that our guys are not giving their lives in vain,” he said.

Rushing to save his patients, Kosulnikov lamented the lack of instruments and modern medicines that plagued his department.

But he said the hospital was usually able to procure needed drugs when soldiers’ lives hung in the balance.

Many uncertainties still remained.

One thing particularly puzzled Kosulnikov.

He estimates that about 50 percent of the wounded soldiers in his service developed antimicrobial resistance before treatment began.

“We ask: “Has he already been in the hospital?” Somewhere else?” Kosulnikov recalls a frequent question.

“They come straight from the battlefield… It’s incomprehensible. We just don’t understand,” he said.

Ukraine has long been known for its high rates of AMR compared to most European countries, as until recently antibiotics were available without a prescription.

The surgeon also suggested that static trench warfare, like World War I, could contribute to the rise in the incidence of AMR.

– “There is no complete victory” –

“We need to better understand the root causes of antimicrobial resistance” as the war continues, said the WHO’s Habicht.

Some of this research is based on monitoring, Habicht said, adding that Ukraine has increased the number of laboratories monitoring drug-resistant bacteria to 100, up from three in 2017.

The US Centers for Disease Control and Prevention, a public health agency, found that “aggressive bacteria are now spreading beyond Ukraine.”

However, Habicht refused to give in to fear-mongering.

He stressed the need to end the war, as well as monitoring and research to ensure proper treatment.

“We don’t want to go back to an era where we can’t treat certain diseases,” Habicht said.

Three weeks after AFP visited the hospital, Sushko returned home with his infection under control.

The hospital team appreciates any success, but Kosulnikov remained calm.

“People before me fought against infections, and after me they will fight against infections. There are some local victories, but there will be no complete victory.”