In a slide presentation at this week's European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) in Copenhagen, Denmark, a team of surgeons and infectious disease clinicians highlighted the complexity and multidrug-resistant, polymicrobial nature of some of the war wounds they are seeing in Ukraine.
The presentation focused on 14 patients with highly complex musculoskeletal infections from gunshot and bomb wounds who were treated at the Center for Musculoskeletal Surgery at the Charite-University Hospital in Berlin from March to December 2022. Of the 14, 13 were colonized with multidrug-resistant gram-negative organisms, including Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Escherichia coli, as well coagulase-negative staphylococci, enterococci, and fungal organisms.
Of 25 gram-negative isolates analyzed, 72% were resistant to carbapenems and newer cephalosporins (ceftazidime-avibactam and ceftozolane-tazobactam), 39% were resistant to cefiderocol, 20% to colistin, and 96% to ciprofloxacin.
"We are dealing with a completely new pathogen spectrum than what we would expect to see in Germany," lead author Maria Virginia Dos Santos, MBBS, said in an ECCMID press release. "In these horrific war injuries, we are seeing high incidence of multi-resistant gram-negative pathogens, and all our cases have been polymicrobial infections."
We are dealing with a completely new pathogen spectrum.
Dos Santos said suboptimal surgical and antibiotic treatment in the often unsterile and low-resource conditions of a war zone likely contributed to the complexity of the wounds.
All of the patients required empiric treatment with a combination of antibiotics, along with removal of dead bone and soft tissue, soft-tissue reconstruction, and reconstructive surgery. Two of the patients have been discharged and returned to Ukraine, eight have no signs of infection and are undergoing rehabilitation, two are still undergoing treatment, and two have developed new acute infections.
In two reports published in Eurosurveillance in December 2022, researchers at hospitals in Germany and the Netherlands reported an uptick in multidrug-resistant organisms linked to patients who had fled or were evacuated from hospitals in Ukraine.