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The number of drug-resistant infections is rapidly rising in Ukraine, according to reports – with the UK’s government agency for health security on alert over a risk of case numbers increasing.
The antimicrobial resistance (AMR) infections occur when bacteria evolves to learn how to defend itself against common antibiotic and other medicines, making treatment ineffective.
Overuse of antibiotics is the main cause of the so-called “silent pandemic” of AMR infections, with a type of infection called Klebsiella pneumoniae now becoming a major issue for hospitals near Ukraine’s frontline.
Last week, the BBC reported on a sharp rise in cases faced by clinicians in Ukraine. While globally, 1.4m people died from AMR infections in 2023. In the same year, 58,000 people had AMR infections in the UK.
The UK Health Security Agency has called it a global crisis with the agency calling for action to drive down infections around the world.
Here, The Independent asks what is helping drive the increase in Ukraine and what can be done about it?
‘Conflict and infectious diseases go hand in hand’
Dr Andrew Edwards, lecturer in molecular microbiology at Imperial College London, said reports of a rapid increase in AMR in Ukraine were “not at all surprising”.
“Conflict and infectious diseases go hand in hand because service personnel are often injured in ways that enable bacteria to get deep into tissues and establish infection,” he said.
“These infections are particularly troublesome when they involve bones and joints because these often involve plastic or metal prosthetics that bacteria can stick to and form protective structures known as biofilms that can resist antibiotics and the immune system.”
Matthew Upton, professor of medical microbiology at the University of Plymouth, said poorer infection control conditions can also increase the spread of infections that are resistant to treatment.
“Conditions are likely to be less clean/hygienic than is usually expected, which increases rates of infection. Mobilisation of populations during war can increase transmission of infections too,” he said.
Professor Adam Roberts from the Liverpool School of Tropical Medicine said those factors alone would lead to a rise in both drug-resistant and susceptible infections.
Prof Roberts, who is also a member of Applied Microbiology International’s One Health Advisory Group, added: “When you combine this with likely supply chain issues for important antibiotics and medicines then you have a situation where resistant bacteria will be able to spread faster from person to person and from hospital to hospital.”
What’s the risk to the UK?
While the reasons for its rapid spread in Ukraine appear to be war-related, and infection control protocols in the NHS are “excellent”, University of Birmingham Professor in microbial evolutionary genomics Alan McNally said the risk was not zero.
“Antimicrobial-resistant bacteria are no different from other pathogens – they spread,” Prof McNally said. “At the moment the primary concern is for Ukraine and Ukraine’s health system, but we should all avoid complacency around antimicrobial-resistant infections.”
Ukraine aside, Prof Roberts said it was a problem on the rise in the UK.
He pointed to a 2023 government report that estimated more than 58,000 people in England had an antibiotic-resistant infection in 2022, a 4 per cent increase on 2021.
”Antimicrobial resistance is an increasing problem in the UK,” he said.
Dr Edwards said it was most worrying in intensive care units and other hospital wards which use the highest quantities of antibiotics.
He added: “However, it’s also a concern in the community, where relatively simple infections such as those of the urinary tract sometimes need to be treated with second or third-choice antibiotics due to resistance. These second choices may not be as effective, prolonging the time needed to cure the patient.”
The UKHSA said it was alert to the risk of increased AMR bugs, both locally and abroad.
The agency’s deputy director Dr Colin Brown said: “Klebsiella pneumoniae is not confined to war zones and our recent surveillance of resistant bloodstream infections in England shows that in 2023, 14 per cent were due to Klebsiella pneumoniae.
“Antimicrobial resistance is not a crisis of the future, but one that is with us right now causing over a million deaths globally each year. Unless action is taken, the availability of life saving treatments will fall and our ability to drive down infections will decrease.”
What can be done to combat the drug-resistant bacteria?
Governments can help by funding more research and development into new antibiotics, and then those new drugs need to be sent to low-income countries which have the biggest issue with the spread of AMR infections, Prof Upton said.
“Funding the development of additional approaches to preventing infection like increased use of vaccines will also help,” he said.
Prof McNally said vaccines help not by fighting the antimicrobial-resistant bacteria itself, but by helping to reduce severe cases of infectious diseases that can lead to serious infections.
There is also work being done at Imperial College with funding from the Scar Free Foundation to help prevent those infections when treating bone and joint injuries, Prof Edwards said. Led by Professor Julian Jones, British Army surgeons, bioengineers and microbiologists are developing materials that will help bones heal while also killing drug-resistant bacteria at the site of combat injuries.
Prof Roberts said fighting antimicrobial resistance required a global response.
“No one country will be able to manage it on their own, AMR pathogens travel as much as we do so they can be anywhere within a day as we carry them around with us,” he said.
