Antimicrobial Resistance Spreading in Wartime Ukraine, 2022

This page summarizes a "Notes from the Field" report in CDC's MMWR by Ukraine's Ministry of Health and Public Health Center, Ukrainian hospitals, CDC and international partners, on work in 2022.

Worldwide, bacterial antimicrobial resistance is estimated to kill more people than HIV or malaria, and is recognized as a leading threat to global health. In Ukraine, high resistance rates before the war, more traumatic wounds, and the strain of war on hospitals are combining to produce more multidrug-resistant organisms, some of which have spread into Europe. Experience from other conflicts such as Iraq, and the long-term consequences for civilians, soldiers and others, make it an urgent crisis to tackle even while the war goes on.

A partnership

In mid-2022, CDC, the Public Health Center of Ukraine, local clinical and public health authorities and international partners, including the World Health Organization's European regional office, ICAP at Columbia University and the European Society of Clinical Microbiology and Infectious Diseases, set out to improve detection, treatment and infection control for antimicrobial resistance in the Ternopil, Khmelnytskyi and Vinnytsia regions, with U.S. supplemental emergency funding for Ukraine.

What the assessments found

In August 2022, teams assessed infection prevention and control and laboratory capacity at the three regional public health facilities and three regional hospitals.

• Infection control: weak surveillance of health care–associated infections; poor implementation of measures such as recommended hand hygiene; little monitoring, evaluation or feedback to staff.
• Laboratories: too little automated microbiology equipment; weak quality and information management, biosafety and staffing; and unreliable supplies for antibiotic susceptibility testing.

Point prevalence surveys

In November–December 2022, surveys at the three regional hospitals found:

These rates are far higher than those in a 2016–2017 European Union survey of more than 300,000 acute care hospital patients and 100,000 long-term care residents, which found a health care–associated infection rate of 5.5%, with 6.2% of infections caused by Enterobacteriaceae (the family that includes Klebsiella) resistant to carbapenems.

What is being done

Urgent capacity building is needed to save lives in Ukraine and limit international spread. Starting in the three regions, the Public Health Center of Ukraine and its partners are:

• strengthening infection prevention and control and the link between laboratories and clinicians through multidisciplinary hospital teams;
• setting up routine surveillance of health care–associated infections and resistance;
• using guidelines and local data to guide treatment;
• upgrading lab equipment and workflows, and training staff;
• making hand-hygiene disinfectants more available and used;
• issuing clinical guidance on when to order bacteriology tests, including for military hospitals;
• "twinning," which pairs international experts with Ukrainian clinicians and laboratory staff for two-way peer mentoring;
• holding workshops to develop standard operating procedures for infection control and patient care;
• supplying laboratories to meet wartime demand, enabling testing against newer antibiotics, and improving hospitals' reliable access to those antibiotics.

Scaling these locally led measures nationally will need continued support, along with national action plans and policies to improve infection control and monitor antibiotic use and resistance.

Sources

• Kuzin I, Matskov O, Bondar R, et al. "Notes from the Field: Responding to the Wartime Spread of Antimicrobial-Resistant Organisms — Ukraine, 2022." MMWR 72(49). https://www.cdc.gov/mmwr/volumes/72/wr/mm7249a5.htm
• European Centre for Disease Prevention and Control, point prevalence survey of health care–associated infections: https://www.ecdc.europa.eu/en/publications-data/point-prevalence-survey-healthcare-associated-infections-and-antimicrobial-use-4