Multidrug-resistant pathogens in crisis-affected hospitals

Abstract

Aim. This study aims to evaluate the prevalence, species distribution, and antimicrobial resistance profiles of multidrug-resistant organisms (MDROs) in hospitals affected by ongoing conflict in Kharkiv, Ukraine, during 2024–2025. The goal is to generate data to support infection control and antimicrobial stewardship in resource-limited, crisis-affected settings. Materials and Methods. An observational study was conducted across five Kharkiv hospitals from January 2024 to December 2025. Clinical isolates were collected from patients with suspected healthcare-associated infections, including bloodstream, urinary, respiratory, and surgical site infections. Bacterial identification was performed using conventional culture methods, and antimicrobial susceptibility testing was performed in accordance with EUCAST standards. Patient demographic and clinical data were analyzed to assess resistance patterns and prevalence. Results. A total of 1313 MDRO isolates were collected, mainly from wound exudates, bronchoalveolar lavage, and urine samples. The most common species were Klebsiella pneumoniae (44.4%), Acinetobacter baumannii (19.9%), and Pseudomonas aeruginosa (13.6%). Resistance to multiple antibiotic classes was widespread, especially among Gram-negative bacteria. The isolates affected a broad age range (1 month to 88 years), with males accounting for 69%. The findings highlight the significant burden of resistant bacteria in conflict-affected hospitals, driven by healthcare disruptions, increased antibiotic use, and compromised infection control. Conclusions. The study demonstrates a high prevalence of MDROs, predominantly Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. Wound, respiratory, and urinary tracts are major reservoirs. These results emphasize the urgent need for enhanced infection prevention, antimicrobial stewardship, and ongoing microbiological surveillance to limit the spread of resistant pathogens. The data provide a crucial baseline for developing policies to combat antimicrobial resistance in conflict-affected healthcare environments. There is an imperative to enhance the capacity of the epidemiological surveillance system by integrating advanced diagnostic technologies and comprehensive information management platforms to facilitate timely detection, reporting, and response to antimicrobial resistance threats in these vulnerable settings.