War injuries and antimicrobial resistance: what impact do multi-resistant pathogens have on the treatment of Ukrainian war- wounded patients?

War injuries are characterized by a high incidence of bone and soft tissue infections caused by multidrug-resistant (MDR) pathogens. We analyzed the influence of infections with MDR pathogens on the course and outcome of 17 Ukranian patients within the first three years of surgical therapy. To assess the clinical course of Ukrainian war-wounded patients treated in our tertiary care hospital between June 2022 and May 2025, the characteristics of hospital stay, number of operations, bacterial spectrum of wound infections and antibiotic therapies were analyzed retrospectively. Patients had sustained mostly severe extremity injuries several months (105.3 ± 25.1 days) prior to admission. The average length of hospital stay was 165.6 ± 29.6 days. An average of 13 ± 3 operations were performed per patient during this time. Secondary limb amputation was required in 3/17 patients (18%). MDR bacteria were detected in 11/17 cases (65%). The most common pathogen (in 9/17 patients (53%)) was carbapenem-resistant Klebsiella pneumoniae. The most frequently detected carbapenemase was New Delhi metallo-beta-lactamase. Due to multiple resistance, antibiotic therapy with ‘last-resort’ antibiotics such as aztreonam/avibactam or cefiderocol was initiated in 12/17 cases (71%). MDR pathogens and high rates of carbapenem resistance are commonly detected in war-injured patients. Traumatized patients should be given special importance in an interdisciplinary treatment concept, given the long hospital stays in a foreign country, MDR pathogens, and imminent amputation of a limb. A successful treatment frequently requires the individualized use of novel antibiotics in combination with radical surgical debridement. III, Retrospective/Cohort analysis