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 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 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

Clinical Sciences

Liverpool School of Tropical Medicine

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

8 Citations (Scopus)

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
Pages (from-to)	101274
Journal	The Lancet Regional Health - Europe
Volume	52
DOIs	https://doi.org/10.1016/j.lanepe.2025.101274
Publication status	Published - 20 Mar 2025

Keywords

Antimicrobial resistance
Genotype
Phenotype
Surveillance

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10.1016/j.lanepe.2025.101274Licence: CC BY-NC-ND

PIIS2666776225000663Final published version, 595 KBLicence: CC BY-NC-ND

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Pallett, S. J. C., Morkowska, A., Woolley, S., 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, 101274. Article 101274. https://doi.org/10.1016/j.lanepe.2025.101274

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

abstract = "BackgroundConflict 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.MethodsCarbapenem-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.Findings100 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).InterpretationExtensively 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.",

keywords = "Antimicrobial resistance, Genotype, Phenotype, Surveillance",

author = "Pallett, \{Scott J C\} and Anna Morkowska and Stephen Woolley 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\}",

year = "2025",

month = mar,

day = "20",

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

language = "English",

volume = "52",

pages = "101274",

journal = "The Lancet Regional Health - Europe",

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Pallett, SJC, Morkowska, A, Woolley, S, 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, pp. 101274. https://doi.org/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. / Pallett, Scott J C; Morkowska, Anna; Woolley, Stephen et al.
In: The Lancet Regional Health - Europe, Vol. 52, 101274, 20.03.2025, p. 101274.

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

TY - JOUR

T1 - Evolving antimicrobial resistance of extensively drug-resistant Gram-negative severe infections associated with conflict wounds in Ukraine: an observational study.

AU - Pallett, Scott J C

AU - Morkowska, Anna

AU - Woolley, Stephen

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 - 2025/3/20

Y1 - 2025/3/20

N2 - BackgroundConflict 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.MethodsCarbapenem-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.Findings100 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).InterpretationExtensively 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 - BackgroundConflict 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.MethodsCarbapenem-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.Findings100 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).InterpretationExtensively 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.

KW - Antimicrobial resistance

KW - Genotype

KW - Phenotype

KW - Surveillance

U2 - 10.1016/j.lanepe.2025.101274

DO - 10.1016/j.lanepe.2025.101274

M3 - Article

SN - 2666-7762

VL - 52

SP - 101274

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

Keywords

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