Conflict zone medical evacuations catalyzing antimicrobial resistance spread and threatening regional health: A retrospective comparative observational study

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.