Occurrence, resistance patterns, and management of carbapenemase-producing bacteria in war-wounded refugees from Ukraine

• DOI: 10.1016/j.ijid.2023.04.394
• Publication Date: 2023-04-16T05:16:25Z
• Authors: Fabian K. Berger; Georges P. Schmartz; Tobias Fritz; Nils Veith; Farah Alhussein; Sophie Roth; Sophie Schneitler; Thomas Gilcher; Barbara C. Gärtner; Vakhtang Pirpilas...; Tim Pohlemann; Andreas Keller; Jacqueline Rehner; Sören L. Becker
• Keywords: 0301 basic medicine; ddc:610; 0303 health sciences; 610; Infectious and parasitic diseases; RC109-216; Antimicrobial resistance; Carbapenemase; Klebsiella pneumoniae; Ceftazidime/avibactam; Pseudomonas aeruginosa; Cefiderocol

We analyzed consecutive clinical cases of infections due to carbapenemase-producing gram-negative bacteria detected in war-wounded patients from Ukraine who were treated at one university medical center in southwest Germany between June and December 2022. The isolates of multiresistant gram-negative bacteria were subjected to a thorough microbiological characterization and whole genome sequencing (WGS). We identified five war-wounded Ukrainian patients who developed infections with New Delhi metallo-β-lactamase 1-positive Klebsiella pneumoniae. Two isolates also carried OXA-48 carbapenemases. The bacteria were resistant to novel antibiotics, such as ceftazidime/avibactam and cefiderocol. The used treatment strategies included combinations of ceftazidime/avibactam + aztreonam, colistin, or tigecycline. WGS suggested transmission during primary care in Ukraine. We conclude that there is an urgent need for thorough surveillance of multiresistant pathogens in patients from war zones.