On February 24, 2022, at around 5:00 a.m., the Russian Federation began bombing Ukrainian cities, irreparably changing the lives of both Ukrainians and the entire world [1]. As of March 2023, only about 8500 civilian deaths have been officially recognized, but the true number is still unknown, as some cities remain occupied and continue to suffer from criminal violence [2]. During the first 6 months of the war, about 8 million people were displaced to the western region of Ukraine, and more than 6.6 million people temporarily left the country. However, the number of wounded among both civilians and the military is currently impossible to estimate [3]. During Russia’s aggressive war against Ukraine, the citizens of the country who remained on its territory, internally displaced persons, refugees, and the military, faced extraordinary problems. In the fierce and bloody war, Ukrainians showed incredible dedication, resilience and solidarity in the face of the enemy invasion. The Armed Forces of Ukraine repelled the attempts of the Russian occupiers to seize the capital in the first days of the war and then made the Russian invaders pay dearly for the captured Ukrainian cities and villages. The Russian aggressors are trying to break the will of Ukrainians to resist by brutally attacking on the battlefield, raping and torturing civilians in the occupied territories, killing, and destroying homes and infrastructure with missiles throughout Ukraine.

The war has hit the developing country’s healthcare system, preventing it from recovering from the severe COVID-19 pandemic. According to official figures, 120 hospitals were damaged in the first 3 weeks of the invasion alone, with about ten of them completely destroyed. Doctors have faced new challenges of working under fire, in shelters and on the front lines in the very epicenter of hostilities [1, 3]. In addition, the war causes special wounds: complex fractures with bone fragmentation, third- and fourth-degree burns, and soft tissue damage from artillery shells and mines. In such conditions, life is the main priority on the front line, followed by hygiene, septic systems, and antiseptics, which contributes to the rapid infection of wounds with explosive metabolites, dirt, and dust [4]. The wounded are provided with medical care from the combat zone, temporary evacuation echelon facilities to the final level of specialized medical care, most often with the use of antibiotics without prior testing. In addition, during evacuation, colonization with antibiotic-resistant microorganisms increases as one moves through different levels of the evacuation chain. [5]. This is especially true for multidrug-resistant Gram-negative bacteria, the colonization of which is likely to result from nosocomial infection in medical facilities along the evacuation route [5]. The prevalence of invasive multidrug-resistant Gram-negative bacteria is high among those who have sustained war-related injuries or received previous treatment in Ukraine [6]. A so-called vicious circle is emerging: the empirical use of broad-spectrum antibiotics during transportation to specialized care facilities saves the lives of the wounded today, but makes the microorganisms completely resistant during subsequent treatment.

When analyzing the phenotypic profile and studying the molecular mechanisms of antibiotic-resistant bacteria isolated from infected wounds of Ukrainian-wounded soldiers, genes encoding carbapenemases of several classes, potent enzymes that cause deactivation of clinically important aminoglycosides, were found in the individual genomes of A. baumannii, P. aeruginosa, and K. pneumoniae [7]. Thus, it has been established that since the beginning of the full-scale war in Ukraine, the multidrug resistance of A. baumannii and K. pneumoniae isolates has reached 75.0% and 80.0%, respectively [8]. At the same time, Ukrainians are characterized by a high frequency of detection of betalactamase-producing bacteria. The proportion of isolation of multidrug-resistant Staphylococcus spp. is about 35.0% among both adults and children [9]. Multilocus sequence typing revealed a striking similarity between isolates isolated in hospitals that are geographically distant. This disturbing fact suggests that such antibiotic-resistant bacteria can spread and gain a foothold in a large number of hospitals, including military hospitals [7].

Given the forced migration of the population, multidrug resistance of wound pathogens is now a problem not only for Ukraine but also for healthcare systems around the world, especially in the EU.

In order to overcome the problem of antimicrobial resistance, the international community adopted the global action plan on antimicrobial resistance, approved by the World Health Assembly Resolution WHA 68.7 of May 26, 2015 [10], and the political declaration of the high-level meeting of the General Assembly on antimicrobial resistance, approved by UN resolution A/RES/71/3 of October 5, 2016 [11].

On March 7, 2019, the Government of Ukraine approved the National Action Plan to Combat Antimicrobial Resistance, which includes combating the unjustified use of antimicrobials in medicine, livestock, poultry, and crop production; controlling the prescription of antibiotics in pharmacies; joining the pan-European network of epidemiological surveillance of antimicrobial resistance and compliance of methods for determining antimicrobial resistance with the standards of the European Union; and joining Ukrainian scientists in the European Union.

However, since the beginning of the full-scale invasion of the Russian Federation, Ukraine’s healthcare system has been under considerable strain in this fierce and bloody war, providing uninterrupted medical care to all the injured and wounded around the clock. Military personnel, refugees, and civilians living in war conditions, being in a state of chronic stress, become more susceptible to the development of infectious complications. Under these conditions, the control and fight against antimicrobial resistance of bacteria have become much more difficult as one of the most pressing challenges for public health at the global level.

For an effective return to antimicrobial resistance measures, it is necessary to withdraw all occupying forces from Ukraine and restore government control over all territories of the country. This will allow for more effective infection control measures in military hospitals and hospitals for refugees and civilians, which will help prevent the transmission of antibiotic-resistant bacteria. Timely and balanced infection control strategies in hospitals and clinics will prevent the spread of resistant isolates and resistance plasmids to preserve the ability to treat critically ill patients with antibiotics. Monitoring of resistant bacteria, antibiotic consumption associated with healthcare for various types of infections, and updating of evidence-based recommendations for their prevention and control should be strengthened. Effective fight against antimicrobial resistance is impossible without continuous and updated information on antimicrobial resistance, identification of risk profiles, their assessment and management, and identification of containment methods.

It is worth remembering that the war is being fought on the territory of one country, but its consequences are irreparable for the whole world.