DOI: 10.12890/2025_005338
Challenges in managing multidrug-resistant infections among refugees: clinical experience during the Ukrainian war
Authors
josu.urbietamancisidor@osakidetza.eus
Keywords
Antimicrobial resistance, refugees, Pseudomonas aeruginosa, Klebsiella pneumoniae, wounds and injuries, conflict-related infectionsAbstract
The war in Ukraine, initiated in 2022, triggered a massive humanitarian crisis with millions displaced. This population exodus posed significant healthcare challenges, including the spread of infections caused by multidrug-resistant (MDR) bacteria. Factors such as disrupted healthcare services, inappropriate antimicrobial use and environmental contamination contributed to increased bacterial resistance.
In this context, in 2023 an 86-year-old Ukrainian migrant was treated in a Spanish hospital for severe infections complicated by MDR bacteria. During hospitalisation, complex resistant strains of Pseudomonas aeruginosa and Klebsiella pneumoniae were identified. Treatment was guided by culture results, though infections recurred multiple times.
A literature review indicated that infections among displaced Ukrainians commonly involve Gram-negative bacteria such as P. aeruginosa and K. pneumoniae, often exhibiting high resistance levels. This underscores the urgent need for infection control strategies, improved antibiotic stewardship and enhanced epidemiological surveillance. Additionally, it highlights the importance of international cooperation and networked efforts in managing antimicrobial resistance during conflicts and mass displacement.
References
- Verkaik NJ, Wielders CCH, den Boer H, Langerak D, Vogel M, Witteveen S, et al. participating laboratories; SWAB Working Group Surveillance of Antimicrobial Resistance. Antimicrobial susceptibility to last-resort antibiotics in carbapenemase-producing bacteria from Ukrainian patients. Microbiol Spectr 2024;12:e0114224.
- Rodero Roldán MdM, Yuste Benavente V, Martínez Álvarez RM, López Calleja AI, García-Lechuz JM. Caracterización de las infecciones de herida entre pacientes procedentes de la guerra ruso-ucraniana en un hospital Role 4. [Characterization of wound infections among patients injured during the Ruso-Ukrainian war in a Role 4 hospital.] Enferm Infecc Microbiol Clin 2024;42:501–506.
- Fuchs F, Xanthopoulou K, Burgwinkel T, Arazo del Pino R, Wohlfarth E, Pavlu F, et al. Coexistence of seven different carbapenemase producers in a single hospital admission screening confirmed by whole-genome sequencing. J Glob Antimicrob Resist 2024;39:184–188.
- Witteveen S, Hans JB, Izdebski R, Hasman H, Samuelsen Ø, Dortet L, et al. Dissemination of extensively drug-resistant NDM-producing Providencia stuartii in Europe linked to patients transferred from Ukraine, March 2022 to March 2023. Euro Surveill. 2024;23:2300616.
- Salmanov A, Shchehlov D, Svyrydiuk O, Bortnik I, Mamonova M, Korniyenko S, et al. Epidemiology of healthcare-associated infections and mechanisms of antimicrobial resistance of responsible pathogens in Ukraine: a multicentre study. J Hosp Infect 2023;131:129–138.
