Evolving antimicrobial resistance of extensively drug-resistant Gram-negative severe infections associated with conflict wounds in Ukraine: an observational study

Scott J C Pallett; Anna Morkowska; Stephen D Woolley; Viktoria V Potochilova; Kateryna L Rudnieva; Olga S Iungin; Vincenzo Sgro; Sara E Boyd; Nicola Reece; Zoe L Lambert; Ngee Keong Tan; Nabeela Mughal; Olena V Moshynets; Luke S P Moore; Matthew K O'Shea

doi:10.1016/j.lanepe.2025.101274

Evolving antimicrobial resistance of extensively drug-resistant Gram-negative severe infections associated with conflict wounds in Ukraine: an observational study

Scott J C Pallett^*
, Anna Morkowska
, Stephen D Woolley
, Viktoria V Potochilova
, Kateryna L Rudnieva
, Olga S Iungin
, Vincenzo Sgro
, Sara E Boyd
, Nicola Reece
, Zoe L Lambert
, Ngee Keong Tan
, Nabeela Mughal
, Olena V Moshynets
, Luke S P Moore
, Matthew K O'Shea

^*Corresponding author for this work

Immunology and Immunotherapy

Research output: Contribution to journal › Article › peer-review

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Abstract

BACKGROUND: 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.

METHODS: 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 p < 0.05.

FINDINGS: 100 isolates were tested (53, 53.0% Klebsiella pneumoniae; 16, 16.0% other Enterobacterales; 18, 18.0% Acinetobacter baumanii and 13; 13.0% Pseudomonas aeruginosa). Gentamicin ( p = 0.0046) and colistin ( p = 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 ( p = 0.006).

INTERPRETATION: 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.

Original language	English
Article number	101274
Number of pages	8
Journal	The Lancet Regional Health - Europe
Volume	52
Early online date	20 Mar 2025
DOIs	https://doi.org/10.1016/j.lanepe.2025.101274
Publication status	Published - May 2025

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Pallett, S. J. C., Morkowska, A., Woolley, S. D., Potochilova, V. V., Rudnieva, K. L., Iungin, O. S., Sgro, V., Boyd, S. E., Reece, N., Lambert, Z. L., Tan, N. K., Mughal, N., Moshynets, O. V., Moore, L. S. P., & O'Shea, M. K. (2025). Evolving antimicrobial resistance of extensively drug-resistant Gram-negative severe infections associated with conflict wounds in Ukraine: an observational study. The Lancet Regional Health - Europe, 52, Article 101274. https://doi.org/10.1016/j.lanepe.2025.101274

@article{e82e8f21da3c4cf1abd53178fdfd4588,

title = "Evolving antimicrobial resistance of extensively drug-resistant Gram-negative severe infections associated with conflict wounds in Ukraine: an observational study",

abstract = "BACKGROUND: 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.METHODS: 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 p < 0.05. FINDINGS: 100 isolates were tested (53, 53.0\% Klebsiella pneumoniae; 16, 16.0\% other Enterobacterales; 18, 18.0\% Acinetobacter baumanii and 13; 13.0\% Pseudomonas aeruginosa). Gentamicin ( p = 0.0046) and colistin ( p = 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 ( p = 0.006). INTERPRETATION: 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.",

author = "Pallett, \{Scott J C\} and Anna Morkowska and Woolley, \{Stephen D\} and Potochilova, \{Viktoria V\} and Rudnieva, \{Kateryna L\} and Iungin, \{Olga S\} and Vincenzo Sgro and Boyd, \{Sara E\} and Nicola Reece and Lambert, \{Zoe L\} and Tan, \{Ngee Keong\} and Nabeela Mughal and Moshynets, \{Olena V\} and Moore, \{Luke S P\} and O'Shea, \{Matthew K\}",

note = "{\textcopyright} 2025 The Authors.",

year = "2025",

month = may,

doi = "10.1016/j.lanepe.2025.101274",

language = "English",

volume = "52",

journal = "The Lancet Regional Health - Europe",

issn = "2666-7762",

publisher = "Elsevier",

}

Pallett, SJC, Morkowska, A, Woolley, SD, Potochilova, VV, Rudnieva, KL, Iungin, OS, Sgro, V, Boyd, SE, Reece, N, Lambert, ZL, Tan, NK, Mughal, N, Moshynets, OV, Moore, LSP & O'Shea, MK 2025, 'Evolving antimicrobial resistance of extensively drug-resistant Gram-negative severe infections associated with conflict wounds in Ukraine: an observational study', The Lancet Regional Health - Europe, vol. 52, 101274. https://doi.org/10.1016/j.lanepe.2025.101274

TY - JOUR

T1 - Evolving antimicrobial resistance of extensively drug-resistant Gram-negative severe infections associated with conflict wounds in Ukraine

T2 - an observational study

AU - Pallett, Scott J C

AU - Morkowska, Anna

AU - Woolley, Stephen D

AU - Potochilova, Viktoria V

AU - Rudnieva, Kateryna L

AU - Iungin, Olga S

AU - Sgro, Vincenzo

AU - Boyd, Sara E

AU - Reece, Nicola

AU - Lambert, Zoe L

AU - Tan, Ngee Keong

AU - Mughal, Nabeela

AU - Moshynets, Olena V

AU - Moore, Luke S P

AU - O'Shea, Matthew K

PY - 2025/5

Y1 - 2025/5

N2 - BACKGROUND: 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.METHODS: 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 p < 0.05. FINDINGS: 100 isolates were tested (53, 53.0% Klebsiella pneumoniae; 16, 16.0% other Enterobacterales; 18, 18.0% Acinetobacter baumanii and 13; 13.0% Pseudomonas aeruginosa). Gentamicin ( p = 0.0046) and colistin ( p = 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 ( p = 0.006). INTERPRETATION: 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.

AB - BACKGROUND: 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.METHODS: 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 p < 0.05. FINDINGS: 100 isolates were tested (53, 53.0% Klebsiella pneumoniae; 16, 16.0% other Enterobacterales; 18, 18.0% Acinetobacter baumanii and 13; 13.0% Pseudomonas aeruginosa). Gentamicin ( p = 0.0046) and colistin ( p = 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 ( p = 0.006). INTERPRETATION: 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.

U2 - 10.1016/j.lanepe.2025.101274

DO - 10.1016/j.lanepe.2025.101274

M3 - Article

C2 - 40224375

SN - 2666-7762

VL - 52

JO - The Lancet Regional Health - Europe

JF - The Lancet Regional Health - Europe

M1 - 101274

ER -

Evolving antimicrobial resistance of extensively drug-resistant Gram-negative severe infections associated with conflict wounds in Ukraine: an observational study

Abstract

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