ANALYSIS OF ANTIMICROBIAL RESISTANCE OF MICROORGANISMS, ISOLATED FROM WAR-WOUNDED PATIENTS (Q2 2025)

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Valentyn ZINKIVSKYI

major of the medical service

leading surgeon of MF&SG “East”

Julia PERINA

major of the medical service

head of the medical intelligence group - leading epidemiologist of MF&SG “East”

Roman KUZIV

Lieutenant Colonel of the Medical Service

Commander of the Military Medical Clinical Center of the Eastern Region

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Introduction

In modern medicine the problem of antimicrobial resistance (AMR) remains one of the major threats. In the context of the ongoing war in Ukraine, it gains particular importance as the number of wounded with purulent-inflammatory complications caused by multidrug-resistant microflora continues to increase.

In the conditions of military medicine, favorable factors for spreading of nosocomial pathogens resistant are emerged, such as: high wound contamination, prolonged hospitalization, repeated surgical interventions, and extensive use of broad-spectrum antibiotic therapy.

In order to comply with the Procedure for enhanced epidemiological surveillance for the antimicrobial resistance of microorganisms (Order of the Ministry of Health of Ukraine № 403, Feb 27 2023) in Q2 2025 there was conducted an analysis of the structure of pathogens and their antibiotic resistance level among patients injured as a result of hostilities.

During Q2 2025, bacteriological studies were conducted on 829 biological samples obtained from hospitalized patients with battle injuries.

Types of biological material:

- wound samples— 398 (48%);

- blood — 424 (51,2%);

- cerebrospinal fluid — 7 (0,8%).

Identification of microorganisms and determination of antimicrobial agents were performed according to EUCAST (2024) standards using the disk diffusion method and automated systems. The resistance level was calculated as the percentage of resistant isolates among those tested.

Results

1. General findings

The overall proportion of positive results was:

- from wounds — 97,2%;

- from blood— 3,5%;

- from cerebrospinal fluid — 14,3%.

2. Structure of isolated microorganisms

From 369 isolates obtained, the predominant pathogens were:

Microorganism	Number	Fraction(%)
Klebsiella pneumoniae	144	43,1%
Pseudomonas aeruginosa	67	20,1%
Acinetobacter spp.	58	17,4%
Escherichia coli	31	9,3%
Enterococcus faecalis	15	4,5%
Enterococcus faecium	12	3,6%
Staphylococcus aureus	7	2,0%

Thus, Gram-negative flora accounted for more than 80% of all isolated strains, which corresponds to current trends in hospital-acquired infections in surgical inpatient conditions.

3. Antibiotic resistance level

Klebsiella pneumoniae

Resistance to β-lactams (Ampicillin, Amoxicillin, Amoxicillin/Clavulanate) — 100%

Carbapenem resistance (Imipenem, Meropenem, Ertapenem) — 78–84%

The highest sensitivity is observed to Amikacin (64.1%), and Tobramycin (70.4%)

➡️ Likely circulation of Carbapenemase-producing strains (KPC, NDM).

Acinetobacter spp.

Resistance level: 51–90.8%

Highest resistance to Imipenem (90.8%) and Levofloxacin (88.8%)

➡️ High multidrug resistance.

Pseudomonas aeruginosa

Resistance level: 13.9–61.1%

The highest sensitivity to Piperacillin/Tazobactam (86.1%) and Ceftazidime (80.6%)

➡️ Carbapenem resistance exceeds 60%.

Escherichia coli

Resistance: 3.2–100%, lowest to Amikacin (3.2%) and Gentamicin (6.5%)

➡️ Likely presence of ESBL-producing strains.

Staphylococcus aureus

Resistance to Cefoxitin — 63.2% (MRSA marker)

Lowest resistance to Linezolid (10.5%).

Enterococcus spp.

E. faecalis: resistance 21.2–81.8%, lowest to Vancomycin.

E. faecium: resistance 30.8–69.2%, lowest to Teicoplanin.

➡️ Emerging trend toward VRE (Vancomycin-Resistant Enterococci) formation

4. Polymicrobial (mixed) infections

96 cases (24.8%) of mixed infections were identified.

The most frequent combinations were:

•K. pneumoniae + Acinetobacter spp. — 34 cases

•K. pneumoniae + P. aeruginosa — 18 cases

•E. faecium + E. coli — 5 cases

•Acinetobacter spp. + E. coli — 5 cases

This indicates a high frequency of mixed purulent processes, which complicates treatment and requires combination antimicrobial therapy.

Discussion

The findings confirm the formation of a high level of antibiotic resistance among the key nosocomial pathogens in patients with battle injuries.

The most problematic remain K. pneumoniae and Acinetobacter spp., which demonstrate a significant resistance to Carbapenems, Fluoroquinolones, and third-generation Cephalosporins.

The high frequency of mixed infections indicates the complexity of the wound microbiological profile and suggests the possibility of horizontal transfer of resistance genes between pathogens.

The obtained data correlates with other findings from Ukrainian and European studies, which also indicate a steady increase in resistance among Gram-negative bacteria in military hospitals.

1)The main pathogens causing wound infections in war-wounded patients remain K. pneumoniae, P.aeruginosa, and Acinetobacter spp.

2)A high level of multidrug resistance was identified, particularly to Carbapenems and Fluoroquinolones.

3)K. pneumoniae demonstrates a total resistance to penicillin and a high resistance to Cephalosporins, indicating the spread of ESBL- and KPC-producing strains.

4)The frequency of mixed infections (≈25%) requires a combination antibiotic therapy.

5)It is essential to strengthen infection control and antibiotic stewardship programs in wounded-care facilities.

Recommendations

Limit the empirical use of Carbapenems.

Apply combination therapy regimens (Piperacillin–Tazobactam ± Amikacin / Linezolid) according to local antibiogram data.

Implement continuous microbiological monitoring and a registry of multidrug-resistant strains.

Ensure strict compliance with infection control protocols in military medical facilities.