Multidrug-resistant bacteria dominate war wounds treated in Ukraine, studies find

Wound infections among people injured in Ukraine's war are dominated by multidrug-resistant bacteria at rates rarely seen outside the sickest hospital wards. In one series of 73 wounded soldiers treated in civilian hospitals in the country's northeast, 84.6% of the bacterial isolates were multidrug-resistant [s1]; in a separate cohort of combat-wound Pseudomonas aeruginosa from three military hospitals in central Ukraine, 60% were extensively drug-resistant and a further 15% multidrug-resistant [s3]. A war fought with blast weapons is turning out to be an antibiotic-resistance event as well as a trauma one.

What the studies counted

The civilian-hospital study examined wound samples from patients with combat injuries treated in the northeast of Ukraine between January and April 2024 [s1]. Bacteria were isolated from 56.16% of samples, with a predominance of gram-negative bacilli; the most frequent species were Acinetobacter baumannii (36%), Enterococcus faecalis (12%) and Bacillus cereus (12%) [s1]. Gram-negative organisms carried more resistance than gram-positive ones — the pattern that makes these infections hard to treat [s1].

A retrospective case series of 100 patients at a referral hospital in western Ukraine fills in the clinical picture behind those isolates [s2]. All were male, injured on the eastern frontlines by blast mechanisms, and reached the study hospital a median of 25.5 days after injury [s2]. Ninety-five per cent met the definition of a complex wound, most often because of tissue necrosis (90%) [s2]. Cultures were taken in half the patients (51%), and of those, 24% (12 patients) grew significant bacteria; antibiotic resistance was found in 9 of those 12 cultures [s2]. Nearly all patients (98%) received intravenous antibiotics, for a mean of 7.3 days, and 99% underwent surgical debridement [s2].

The genomic study sequenced 40 P. aeruginosa isolates taken from the wounds of 171 injured soldiers at three military hospitals during 2022–2023 [s3]. It found high-risk international clones — sequence types ST773 (32.5%) and ST1047 (25.0%) predominating — carrying the carbapenemase genes blaNDM-1 and blaIMP-1, which disable one of the last widely used classes of antibiotics [s3]. All isolates remained susceptible to colistin, an older and more toxic drug now pushed back toward the front line [s3]. Genetically related clusters appeared across different hospitals, which the authors read as inter-hospital transmission rather than independent emergence [s3].

Why war wounds breed resistance

The mechanism is not mysterious. Blast injuries are heavily contaminated and devitalised; evacuation across a contested country is slow, so wounds sit for weeks before definitive care — the median in the western-hospital series was more than three weeks [s2]. Broad-spectrum antibiotics are given early and often as a hedge in austere, high-risk conditions, and that pressure selects for the organisms that survive it. The trauma-surgery authors are explicit that their near-universal intravenous antibiotic use reflects cautious combat-trauma practice, and they call for wartime-adapted antibiotic-stewardship frameworks rather than blanket prescribing [s2]. None of this is unique to Ukraine — it is how conflict drives resistance generally — but the scale and the carbapenemase genotypes here are striking.

What the studies cannot say

These are single-centre series with modest numbers — 73, 100 and 40 isolates from 171 soldiers — and they describe the patients who reached a given hospital, not a representative sample of everyone wounded [s1][s2][s3]. Resistance frequencies from cultured wounds overstate the rate across all wounds, because clinicians culture the wounds that look infected. The studies report which bacteria were present and what they resisted; they do not, on their own, establish how often those infections changed outcomes such as amputation or death. In the trauma cohort, 2% of patients underwent amputation during their hospital stay and the median length of stay was 14 days [s2], but the design cannot attribute those directly to resistant organisms.

Why it matters beyond the front

Wounded soldiers and civilians are evacuated from Ukraine to hospitals across Europe, and the carbapenemase-bearing clones documented here travel with them. The signal of inter-hospital spread within Ukraine [s3] is the same signal that European infection-control teams watch for when they receive transferred patients. Ukraine's health system has shown it can rebuild physical capacity under fire — its radiotherapy network is larger now than before the invasion — but drug-resistant infection is a burden that crosses borders with the patients, and it is not solved by new machines.

What to watch

Two things are measurable from here. The first is whether stewardship and microbiology capacity can be built inside wartime trauma pathways, given that broad IV antibiotic use is currently the norm [s2]. The second is the spread of the specific high-risk clones — ST773 and ST1047 carrying blaNDM-1 and blaIMP-1 [s3] — through the European hospitals that receive Ukraine's wounded. Colistin susceptibility [s3] is the current backstop; the thing to watch is whether it holds.

Sources

• War impact on antimicrobial resistance and bacteriological profile of wound infections in Ukraine, Communications Medicine, 24 September 2025
• Clinical epidemiology, microbiology, and care of war-related wounds in Ukraine, Journal of Trauma and Acute Care Surgery, 1 May 2026
• Genomic diversity and antibiotic resistance determinants of Pseudomonas aeruginosa associated with war-wound infections in Ukraine, Journal of Hospital Infection, 16 July 2026