International spread of antimicrobial resistance in 2022: Genomic surveillance of multidrug-resistant isolates from Ukrainian Patients in a German health facility (Preprint)

Abstract

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.