Antimicrobial Resistance in Ukraine—What Healthcare Providers Need to Know when Treating Ukrainian Refugees

The scoping review assesses the trends in clinical infectious diseases reporting antimicrobial resistance (AMR) in Ukraine following a year of full-scale Russo-Ukrainian war (2022) to offer recommendations for healthcare providers caring for patients traveling from Ukraine. Background: Until 2019, antibiotics were available to Ukrainians over the counter, and there was no systematic program to monitor bacterial resistance. Only in 2023 did a document standardizing the rational use of antibacterial and antifungal drugs become available for Ukrainian healthcare providers. By 2020, high levels of carbapenem-resistant bacteria were reported in military hospitals, 29.5%–64.2%, with Acinetobacter baumannii particularly problematic. Nosocomial infections were significantly more common in Ukraine than in the European Union, 14% vs. 5.5%, with 60% of these infections due to organisms resistant to carbapenems. Methods: A systematic review of PubMed database for articles published in 2023–2024 was conducted with the keywords “Ukraine”. All articles reporting on AMR were reviewed, and knowledge syntheses were performed. Results: The review identified 298 articles reporting on a wide range of infectious diseases in Ukraine, with COVID-19, HIV, and tuberculosis being the most prevalent subjects. Twenty-nine articles reported on AMR both within Ukraine and among Ukrainian patients treated at hospitals across Europe. High prevalence of extended-spectrum beta-lactamase (ESBL), particularly among healthcare-acquired infections and among pediatric population reported: E. coli 23.5%–46.2%, Enterobacter spp. 5.9%–27.2%, Klebsiella pneumoniae 5.9%–77.5%, along with carbapenem resistance: E. coli 1.0%–23.9%, Klebsiella pneumoniae 17.6%–53.6%, Acinetobacter baumanii 14.7%–74.7%, Pseudomonas aeruginosa 8.8%–67.9%. Prevalence of methicillin-resistant Staphylococcus aureus among pediatric population remains very low. Conclusions: AMR remains a critical concern for Ukrainian patients, exacerbated by the ongoing war and healthcare challenges. ESBL and carbapenem resistance are highly prevalent. U.S. healthcare providers should consider antimicrobial resistance while caring for patients with significant prior nosocomial exposure in Ukraine and advocate for strong and sustainable healthcare infrastructure worldwide to control and prevent the spread of infectious diseases.