The Consequences of War

In 1938, British politician Neville Chamberlain cautioned that in conflict, no party emerges victorious; all are left with losses. Unfortunately, this truth often goes unheeded. War has consistently scarred humanity's history and remains a pressing issue today.

However, one unexpected "winner" in warfare is bacteria. The harsh realities of combat zones create ideal conditions for the emergence of antibiotic resistance. As infections and injuries spike during warfare, there is an increased dependence on antibiotics. Yet, the tumult of war—characterized by scarce resources, overcrowded medical facilities, and poor hygiene—often hampers effective healthcare and infection control.

The misuse and overuse of antibiotics, coupled with inadequate sanitation, create a breeding ground for drug-resistant pathogens. As the need for hospital beds escalates, wounded individuals are rapidly moved to any available space, facilitating the spread of antibiotic-resistant bacteria initially acquired during treatment.

Emergence of a Crisis

The Lund University study monitored antimicrobial-resistant infections among hospitalized victims from February to September 2022, during the initial phase of the conflict. Researchers collected samples from patients suffering from severe burns, shrapnel injuries, and fractures. In total, they analyzed 154 samples from 141 patients.

The findings are troubling:

• 58% of the samples revealed bacteria resistant to meropenem, a powerful antibiotic, including strains of Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp.
• Alarmingly, 9 isolates showed resistance to all antibiotics, even the newer beta-lactam/beta-lactamase inhibitor combinations.

The researchers raise a critical warning:

Infectious complications arising from trauma and surgical interventions are common. Despite having access to broad-spectrum antibiotics such as colistin and cefiderocol, hospital-acquired infections remain difficult to manage. Ukraine's healthcare system is under extreme strain due to limited resources, making it hard to uphold infection prevention and control measures, which may further facilitate the spread of resistant bacteria.

Support from neighboring European nations, particularly in terms of antimicrobial resources and care for war victims, could alleviate some of these dire challenges.