Superbugs are spreading in Europe

KYIV – In the waiting area of the Superhumans Center in the Ukrainian city of Lviv, two patients, one in a wheelchair with an arm and two legs amputated, are playing table tennis as others watch on. A massive screen is showing relaxing scenes of nature, with an accompanying soothing soundtrack playing in the background.

Danylo Turkevych, the head of the surgery department – who started his medical practice right as the full-scale Russian invasion began – said the challenge during the war of achieving fast and effective medical care for those on the front lines has been immense.

“Evacuation of patients would take two to three weeks, sometimes even months, to get them from Dnipro, Donetsk and Kharkiv to Lviv,” he says of the early days of the conflict, when he worked at a state hospital.

However, in many ways the challenges have only grown since then.

Wartime conditions in Ukraine have created an ideal environment for serious antibiotic-resistant infections to develop. These so-called “superbugs”, which are resistant to many, if not all, commonly used antibiotics, can be deadly and spread far.

The most concerning is Klebsiella pneumoniae, a bacteria estimated to be responsible for over 100,000 deaths a year.

When it comes to Ukraine, a combination of overcrowded hospital wards, weak infection control and micro-dosing of antibiotics to prolong supplies are resulting in the spread of superbugs.

Turkevych says the situation with AMR is going from bad to worse. “I may be a fatalist but I think we are already in the post-antibiotic era, because it’s not only a Ukrainian problem, it’s a problem in the whole world,” he said.

Rising death toll

According to a report in The Lancet, 1.14 million deaths globally in 2021 were directly attributed to antimicrobial resistance (AMR). From 2025 to 2050, researchers forecast that more than 39 million deaths will be linked to AMR.

Meanwhile, as Ukrainian patients with war-related wounds have been evacuated to hospitals across Europe, difficult-to-treat infections have been reported in Germany, Denmark and the Netherlands.

A study by the University of Helsinki and HUS Helsinki University Hospital found that of the eight per cent of Ukrainian refugees who had been hospitalised for war-related injuries, close to 80 per cent carried multi-drug resistant (MDR) bacteria.

“We strongly recommend targeted MDR screening and strict contact precautions for patients hospitalised in conflict zones,” it said.

Richard Sullivan, the co-director of the Centre for Conflict & Health Research at Kings College London, said that European programmes tend to be focused on high-threat infectious diseases such as dengue fever and rabies, leaving gaps in how antimicrobial resistance is tracked.

He told The i Paper that while some hospitals have been good at swabbing and looking for resistant infections, others have not been so good. “The problem is there’s so many other things going on that until we have a massive crisis, it’s very hard to do something about this.”

“We are living in a world where there is no money. The idea that we’re going to coordinate and do better surveillance is lovely on paper. In reality, unless there is government‑mandated reporting and analysis, it doesn’t get done,” Sullivan said.

A worrying technique

When antibiotic resistance expert Olena Moshynets, a microbiologist at The Institute of Molecular Biology and Genetics in Kyiv, started her research on AMR resistance a decade ago, there were already multiple-drug resistant bacteria in the country.

“Ukraine was more isolated, a lot of people travelled abroad, but they were healthy,” she said. Now, with Ukrainian wounded being sent for treatment abroad, that is often not the case.

Meanwhile, a technique called negative pressure wound therapy, which is a technique using a suction pump, tubing, and a dressing, creates further problems.

“It was a really good way to close soft tissue,” said Turkevych. “But people tend to overuse it and you then have a high risk of growing bacteria deep in the soft tissue of the bone. Due to that, we had a huge number of delayed amputations.”

In February, Turkevych operated on a patient with an infection of the tibia bone. “In this scar tissue, there was dense fabric from his trousers and metal particles from the explosion, we had to cut all that off, clean the wound and then do an operation to close the defect,” he said.

The patient was able to keep his limb, but others are not so fortunate, and amputation often becomes the only way to stop the spread of infection, Turkevych said.

“If you get multi-drug-resistant bacteria and we are able to treat it, sometimes amputation is the only possible way to salvage the person,” he added. “If it’s not amputated it will spread.”

In some patients, even amputation is not enough to stop the antibiotic-resistant infections proliferating.

“It won’t kill you but there are studies that show the patient will produce that bacteria in two or three years after the initial surgery,” Turkevych said. “You’re basically becoming a biological weapon.”

A country on the edge

Prevention is better than a cure, but a severe lack of funds and essential medication is making it almost impossible in Ukraine to address the root causes.

The first step is to bring back nurses, says Moshynets. “We may have one nurse for each 30 beds. It’s impossible to keep on top of infection prevention and control, it doesn’t matter how great the nurse is.”

She added that while the official position of Ukraine’s health ministry is that they have funds to cover all needed medication, the reality on the ground is very different.

“My colleagues, just normal doctors, tell me their salaries have been reduced and they don’t have normal antibiotics, even in Kyiv. That’s a big problem when it comes to AMR,” she said.

The State Institution Center of Public Health of the Ministry of Health of Ukraine, which is responsible for infection prevention and control as well as antimicrobial resistance and related data, did not reply to a request for comment.

This acute shortage makes healthcare outcomes far worse for patients. Moshynets recalls a recent case where a patient had a liver abscess as a result of a case of Klebsiella. After their first unsuccessful treatment, the clinician reached out to Moshynets for advice.

“The strain was already resistant to the first antibiotic that was used,” she says. But when Moshynets when back to ask why this was given to the patient, she was shocked by the doctor’s reply: “He said that was the only antibiotic we had.”

For Sullivan, his fear is that infections originating from the battlefields of Ukraine could soon spread across the rest of Europe.

“Modern battlefields like Ukraine create the perfect storm for AMR,” he said. “Massive environmental toxicity, ordnance and destroyed infrastructure, contaminated wounds, long evacuation pathways as well as mobility from hospital to hospital create the ideal conditions for AMR, which is no respecter of borders.”

Ultimately, Sullivan said, monitoring closely and having a better understanding of where and how to mitigate the threats is “crucial for stopping the wider spread of AMR”.