Antimicrobial resistance among clinical isolates associated with combat-related infections in Ukraine: first nationwide surveillance, 2023-2024

Antimicrobial resistance (AMR) is a critical global health threat, which reduces the effectiveness of treatment and drives higher morbidity, mortality, and costs. In Ukraine, the problem has been further aggravated by Russia's full-scale invasion, with favorable conditions for the spread of resistant pathogens. We characterized the isolation frequencies and resistance patterns among main ESKAPE pathogens in combat wound infections in Ukraine in 2023-2024 ̶ Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. Among 40,823 microbial strains isolated 18,848 were identified for surveillance. Approximately 1,000 isolates of MDR Gram-negative organisms submitted for verification at the Reference Laboratory confirm the ongoing spread of multidrug-resistant (MDR) hospital-acquired pathogens in Ukraine. We found that ~60% of verified K. pneumoniae strains carried MBLs conferring near-pan resistance to β-lactams. We provided enhanced epidemiological surveillance data on antimicrobial resistance in microorganisms causing wound infections among combat-injured patients, along with antimicrobial prescribing practices, which underscore the urgent need for coordinated antibiotic stewardship and infection control programs adapted to wartime conditions. Our findings further support the establishment and strengthening of sustained surveillance of ESKAPE pathogens in wartime wound infections, alongside broader capacity-building efforts within healthcare systems.