Ukrainian doctors treat wounded soldiers like biological attack victims to cut amputation risk from resistant infections

A pilot project begun in September in the Ukrainian city of Dnipro has wounded soldiers washed and treated with antiseptic before they receive hospital care. It is led by Hailie Uren, an Australian clinical pharmacologist who has worked in Ukraine for four years. The idea is to treat antibiotic-resistant bacteria much like a biological weapon and decontaminate patients as quickly as possible, which could help avoid amputations and limit the spread of dangerous bacteria. The New York Times reported on the effort in late October, and Meduza summarized that reporting.

Why the infections are so dangerous

Combat injuries today are caused more often by mine and drone blasts than by bullets. Explosions damage tissue badly and drive dirt and bacteria deep into wounds. Because of the drone threat, evacuation can be delayed for days or even weeks, and the wounded are moved by land, so reaching a suitable military hospital quickly is not always possible. Heavy blood loss and lack of food leave soldiers less able to fight bacteria.

As a result, serious wound infections develop in 30% to 40% of wounded soldiers. Many of the bacteria are resistant to many or even all antibiotics. When a limb is wounded, saving a life may require removing much more of it than would be needed without infection. Patients can stay hospitalized for a long time, sometimes more than a year. The bacteria can also spread to other hospitals, including abroad, where Ukrainian soldiers are treated.

How resistance develops

Uren concluded that improper antibiotic use drives resistance. The first doctor to see a soldier may give whatever is on hand rather than what guidelines recommend, and later doctors, unaware of what was already given, prescribe further drugs. Hospitals sometimes prescribe antibiotics unnecessarily or choose broad-spectrum drugs. Stabilization points often lack water, antiseptics, staff and laboratories.

The Dnipro trial

Before the trial, medical staff held a four-day rehearsal in Poland, practicing removing dirty uniforms, cutting away soiled bandages, removing catheters and cleaning wounds. In a large tent outside a Dnipro hospital, 150 soldiers went through the procedure over a month. There are no official results yet, but in one soldier's case a dangerous bacterium found on arrival was gone a few days after the procedure.

The organizers plan to set up similar tents outside two more hospitals.