Purpose Antimicrobial resistance is a pressing issue in Ukraine, with healthcare-associated infections caused by multidrug-resistant organisms being a major concern. A recent prospective multicenter study revealed a staggering rate of 48.4% antimicrobial resistance to carbapenems among Enterobacterales causing a healthcare-associated infection. We conducted a systematic survey to investigate the incidence rate and incidence density of carbapenemase-producing Gram-negative bacteria (CPGN) among refugees and war-wounded Ukrainians in connection with the German health system. Methods From the onset of the war until November 2022, seven Ukrainian patients were admitted to our hospital. Upon admission, screening samples and samples from the focus of suspected infection were taken from all seven patients. The incidence rate and the incidence density of CPGN were calculated as a result of the microbiological findings. We sequenced all CPGN using Illumina technology. Results The incidence rate of CPGN at our hospital was 0.06 for 2021 and 0.18 for 2022. All seven Ukrainian patients were infected or colonized with at least one CPGN, including K. pneumoniae (14/25), P. aeruginosa (6/25), A. baumannii (1/25), Providencia stutartii (1/25), C. freundii (1/25), and E. coli (2/25). Genomic surveillance revealed that (i) most frequently detected carbapenemases among all sequenced isolates were blaNDM (17/25) and blaOXA-48 (6/25), (ii) most commonly observed plasmid replicons among the K. pneumoniae isolates recovered from Ukrainian patients were Col(pHAD28) (12/14), IncHI1B(pNDM-MAR) (9/14), IncFIB(pNDM-Mar) (12/14), and (iii) clonal relation between the pathogens of the Ukrainian isolates, but not for the isolates from our hospital surveillance system. Conclusion The rising prevalence of community-acquired colonization and infection with CPGN is having a direct effect on the infection prevention measures, such as higher number of isolations, reprocessing of patient rooms, additional microbiological testing and overall organization within hospitals.

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BACKGROUND Experts are increasingly sounding the alarm: the ongoing war in Ukraine could lead to the spread of antimicrobial resistance across Europe. OBJECTIVE Our report focused on the genomic analysis of multi-drug resistant pathogens collected from Ukrainian soldiers and refugees who were treated in a German hospital. METHODS In 2022, seven Ukrainian war-injured soldiers were admitted to our tertiary care hospital. Upon admission, screening samples and samples from the focus of suspected infection were taken. At our 1400-bed hospital, we have implemented a routine whole genome sequencing for all carbapenemase-producing Gram-negative bacteria (CP-GN), regardless of whether colonization or infection occurred. RESULTS All Ukrainian patients were infected or colonized with at least one carbapenemase-producing Gram-negative bacteria, including carbapenemase-producing K. pneumoniae, P. aeruginosa, A. baumannii, Providencia stutartii, C. freundii, and E. coli. Genomic surveillance revealed that i) detected carbapenemases were mostly NDM-1 and OXA-48 – which are not inhibited my most of the novel carbapenemase-inhibitors, ii) a C. freundii isolate with mcr-9 resistance gene conferring resistance to colistin and iii), we mostly detected isolates belonging to sequence type 395 (7/13) among the Ukrainian K. pneumoniae isolates. CONCLUSIONS Migration resulting from the ongoing Ukrainian war will expedite the dissemination of hard-to-treat carbapenemase-producing pathogens. Our experience suggests that screening and preventive isolation upon admission is essential for the care of Ukrainian patients in order to prevent the entry of hard-to-treat carbapenemase-expressing bacteria into the hospital.