Evolving antimicrobial resistance of extensively drug-resistant Gram-negative severe infections associated with conflict wounds in Ukraine: an observational study.
retrospective_cohort · Level III
Where this comes from
- Record sourced from PubMed, PMID 40224375.
- Also identified by DOI 10.1016/j.lanepe.2025.101274 and PMC identifier 11987627.
- Licence recorded as CC BY-NC-ND.
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Abstract
Conflict can have devastating effects on the development and spread of antimicrobial resistance. In Ukraine, early data post-injury are limited. We aim to explore extensively drug-resistant (XDR) Gram negative phenotypes and genotypes for infections arising early following conflict-associated wounds in Ukraine. Carbapenem-resistant infections following conflict-associated wounds in Ukraine (February-May 2024) underwent extended antimicrobial susceptibility testing (AST) for 19 antimicrobial agents using 2025 European Committee for Antimicrobial Susceptibility Testing breakpoints. Carbapenemase genes were identified using a novel multiplex molecular resistance assay. Infections arising in the first seven days versus those arising after seven days since injury were compared by logistic regression. Significance was set at <i>p</i> < 0.05. 100 isolates were tested (53, 53.0% <i>Klebsiella pneumoniae</i>; 16, 16.0% <i>other</i> Enterobacterales; 18, 18.0% <i>Acinetobacter baumanii</i> and 13; 13.0% <i>Pseudomonas aeruginosa</i>). Gentamicin (<i>p</i> = 0.0046) and colistin (<i>p</i> = 0.049) resistance were higher in infections arising later. Overall, resistance rates for amikacin (74/100, 74.0%), cefiderocol (44/100, 44.0%) and ceftazidime-avibactam (26/79, 67.1%) were observed. Prevalent resistance genes included NDM + OXA-48-like (24/100, 24.0%), NDM-only (24/100, 24.0%) and KPC (9/100, 9%). Others included OXA 23-like/51-like, IMP and/or mcr1. Earlier infection isolates had a higher burden of carbapenemases/isolate (<i>p</i> = 0.006). Extensively drug-resistant infections were observed early post-injury in Ukraine, with some trend to further resistance in those arising later in the patient pathway. A diverse presence of carbapenemase genes amid XDR Gram negative phenotypes highlights the importance of early screening for mechanisms of resistance in this setting. This study was funded by the Healthcare Infection Society and CW+ Charity.