Drug-resistant infections put wounded Ukrainian soldiers at risk of amputation. Doctors are trying to help by treating them like victims of a biological attack.

In late October, The New York Times published a report on how doctors are helping Ukrainian soldiers fight antibiotic-resistant infections. Correspondent Marc Santora traveled to Dnipro and Poland, spoke with doctors and patients, and joined science reporter Gina Kolata to examine the problem and a potential solution. Here, we summarize their reporting alongside additional details from the participating doctors’ interviews, presentations, and scientific papers.Antibiotic-resistant bacteria are forcing doctors to perform extensive amputations on soldiersHailie Uren is a clinical pharmacologist from Australia. Part of her job is to ensure antibiotics are prescribed properly: only when strictly indicated and as targeted as possible, keeping the use of broad-spectrum drugs to a minimum. Uren has worked in Ukraine for four years now, helping wounded soldiers avoid amputations.Combat injuries today are caused more often by mine and drone blasts than by bullets. Explosions do far worse tissue damage and drive dirt — and the bacteria in it — deep into wounds.Drones create another problem: wounded soldiers cannot be taken to a hospital right away. Evacuation teams have to wait until drones no longer pose a threat, which can take days or even weeks. When evacuation does happen, soldiers are transported by land rather than by air, so getting a patient to a suitable military hospital quickly is not always possible. Weakened in the meantime by heavy blood loss and a lack of food, the wounded soldier is less able to fight off dangerous bacteria.As a result, serious wound infections develop in 30% to 40% of wounded soldiers. Worse still, the bacteria behind these infections are resistant to many or even all antibiotics. Sometimes a single patient is colonized by several types of these bacteria at once.When an arm or a leg is wounded, saving the patient’s life is likely to require amputation, and doctors have to remove much more of the limb than they would without an infection. Patients whose wounds are infected with antibiotic-resistant bacteria can remain hospitalized for a long time, sometimes for more than a year. That takes a toll on their mental health and strains the healthcare system.These bacteria can also take hold in the military and civilian hospitals the patient passes through and cause severe new infections in others, including other blast victims. And because Ukrainian soldiers are sent to other European countries and the United States for treatment, the bacteria can gain a foothold there as well.What makes bacteria antibiotic-resistant is antibiotics themselvesWhen Uren arrived in Ukraine, she saw that local hospitals were overrun with antibiotic-resistant bacteria. Around the world, health systems combat this by strictly monitoring how the drugs are used. Giving antibiotics whether they are indicated or not — “just in case” — and defaulting to broad-spectrum drugs create conditions in which only antibiotic-resistant bacteria survive.Ukraine began implementing a system to prevent this in 2021 but had not completed it before the full-scale war began. Despite the fighting, Uren initially tried to improve antibiotic prescribing at a civilian hospital. She began making progress, but she quickly realized it was impossible to put a proper system in place under wartime conditions. Nor did that solve the problem of soldiers arriving for treatment with infections that were already resistant to antibiotics.Uren spent a long time trying to figure out how wounded soldiers were arriving at their very first hospital already carrying dangerous bacteria. She concluded that several factors were at play.Official Ukrainian guidelines say a wounded soldier should be given antibiotics at the earliest opportunity, before even reaching a hospital. For certain injuries, all soldiers are also supposed to receive antibiotics from another class, on the theory that this improves the chances of defeating dangerous bacteria. In practice, the first doctor to see a wounded soldier may give whatever is on hand rather than what the guidelines recommend — and doctors at later stages of treatment, not knowing what was already given, may prescribe still other antibiotics, only helping dangerous bacteria thrive.Inside hospitals, medical staff also follow flawed prescribing practices, ordering antibiotics when they are unnecessary and reaching straight for drugs that should be held in reserve. At each military hospital a wounded soldier passes through — and there can be three or more — doctors prescribe new antibiotics based on their own judgment and frequently choose broad-spectrum drugs.Meanwhile, the first place a wounded soldier receives care — a stabilization point — often lacks enough water and antiseptics to flush a wound, or simply enough staff, to say nothing of a lab that could identify the bacteria causing an infection and determine which narrow-spectrum antibiotic would work best. The civilian and military hospitals that receive patients later are also severely short-staffed, leaving wounded soldiers waiting for care in dirty clothes and old bandages.All of this creates favorable conditions for antibiotic-resistant bacteria to multiply and spread to other patients.The solution sounds simple, but in practice it takes a lot of effortAt some point, Uren decided to treat these bacteria like a biological weapon. “If we don’t have antibiotics to treat these patients,” she told The New York Times, “how different is that from when a patient is exposed to anthrax?” When a biological weapon is used, decontaminating patients as quickly as possible is critical and directly affects survival rates. Uren decided to take that approach.Before the trial began, Ukrainian doctors, nurses, and other medical staff held a four-day rehearsal in Poland. They practiced stripping off dirty uniforms, cutting away soiled bandages, removing catheters, and cleaning wounds while keeping themselves safe.In Ukraine, the trial began in September in a large tent outside a hospital in Dnipro. There, wounded soldiers were undressed, washed, and treated with antiseptic before being sent on for treatment; previously, they could end up in an operating room still in their dirty clothes. Over a month, 150 soldiers went through the procedure. There are no official results yet, but Uren sees reason for hope: in one soldier’s case, a dangerous bacterium found in his wound upon arrival was gone a few days after the procedure.The shower also had an effect that doctors did not anticipate. “The casualties consistently are telling us they feel like they are a human again,” Uren said. “It’s like we are washing off the war from them.”Those behind the initiative hope this is only the beginning. They want these procedures to start even earlier — and, ideally, to see antiseptics and clean water included in every soldier’s standard-issue gear. As for antibiotics, Uren and her colleagues say only narrow-spectrum drugs should be given preventively, with additional antibiotics reserved for cases where an infection has already developed.For now, the project’s organizers are planning to set up similar decontamination tents outside two more hospitals.At Meduza, we are committed to transparency about our use of artificial intelligence in the newsroom. The story you’re reading was written by one of our living, breathing journalists and translated from Russian using an AI model configured to follow our strict editorial standards. This translation process is the result of extensive testing and refinements to ensure our English-language coverage is timely and accurate. 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