Ukraine Becomes World’s First ‘Post-Antibiotic War’ as Wounded Fighters Carry Superbugs Home

Before a wounded Ukrainian soldier is carried into one hospital in Dnipro these days, he is stripped, washed and swabbed with antiseptic inside a large tent outside its doors. Medics cut away dirty bandages, pull out catheters and bag up filthy uniforms. The routine comes from the playbook for a biological weapons attack.The enemy in this case is bacteria.About 150 soldiers went through the tent in its first month, according to a report on the trial, which began in September. The idea came from Hailie Uren, an Australian clinical pharmacologist and chief specialist for antimicrobial resistance and infection control at Ukraine’s Public Health Center. No official results have been published, yet organizers plan to set up tents at two more hospitals, and a backer, Razom for Ukraine, aims for a nationwide rollout by 2027.The tents respond to grim numbers. Serious infections develop in 30 to 40 percent of wounded soldiers, and the bacteria behind them often resist many or all antibiotics. Some patients stay in the hospital for more than a year.For one American physician studying those wounds, the stakes reach well past Ukraine.“Wounded soldiers develop infections resistant to nearly all available antibiotics, which leads to significant complications including amputations and deaths,” a professor of emergency medicine at the University of Colorado Anschutz, Dr. Adit Ginde, tells The New York Sun. “This is a disturbing glimpse into a potential future where antibiotics may not be effective and even routine infections can become life-threatening.”So is Ukraine the first battlefield of a post-antibiotic age, and are the men who survive it carrying that threat home with them?Infected Before the Operating TableIn late 2024, the chief surgeon at Dnipro’s Mechnikov Hospital, Dr. Sergiy Kosulnykov, estimated that about half of the wounded soldiers admitted to his department already carried resistant infections.How this war is fought explains much of it.In Iraq and Afghanistan, wounded Americans often reached surgeons within about two hours. In Ukraine, drones, which by some estimates now cause more than 80 percent of casualties, can trap the wounded for days or weeks. Blasts drive soil deep into flesh, and stabilization points often lack clean water, antiseptics and labs, so medics give whatever antibiotics they have. Dr. Ginde leads ARROW, a Pentagon-funded study tracking combat trauma patients at five Ukrainian hospitals.Where soldiers pick up the bacteria is disputed. Ukrainian and Walter Reed Army Institute of Research scientists who swabbed wounds soon after injury published a letter in the New England Journal of Medicine in February pointing to infection after casualties reach larger hospitals.One of the researchers behind that work, however, rejects the doomsday label now attached to this war.“I wouldn’t call it a ‘post-antibiotic war.’ Antibiotics still work for most wounded soldiers. But the problem is very serious,” the scientific director at the Ukrainian Institute on Public Health Policy, Dr. Kostyantyn Dumchev, tells the Sun. “Resistant strains are most likely acquired later, in hospitals.”“They are carried from one patient to another on the hands of medical staff and on instruments, dressings and equipment that aren’t properly cleaned, especially during wound care,” Dr. Dumchev says.An American who has spent a decade financing new antibiotics reads the evidence the same way.“It’s not the bombs themselves or what the drones are dropping,” a professor of law at Boston University who runs the antibiotic accelerator CARB-X, Kevin Outterson, tells the Sun. “It’s really difficult to maintain modern infection prevention and control standards when you’re worried about artillery fire or drone strikes.”In other words, the greater danger lies less on the battlefield than along the long, crowded road away from it. Ukraine now moves many casualties out of the kill zone on small remote-controlled ground vehicles.“But that needs to be cleaned, and they’re focused on survival,” Mr. Outterson says, noting that Acinetobacter, one of the bacteria now plaguing Ukraine’s wards, was once nicknamed “Iraqibacter.” “So this would be true in lots of places where a conflict was grinding on and degrading the health care system.”With the latest American-brokered peace talks in Abu Dhabi ending Wednesday without a breakthrough, that road shows no sign of closing. Nor does it stop at Ukraine’s border.Foreign Fighters Carry the Bugs OutUkraine’s foreign legion has drawn thousands of volunteers since 2022, including Americans. Researchers from Walter Reed and the Army’s Landstuhl Regional Medical Center in Germany studied foreign fighters wounded in Ukraine. The soldiers were evacuated to Landstuhl between November 2022 and March 2024. The study, published in the Journal of Infectious Diseases, found 86 clinically significant drug-resistant organisms in 32 fighters from 10 countries.Several samples resisted cefiderocol — an antibiotic approved in 2019 that sneaks through the tough outer membrane of drug-resistant bacteria — or aztreonam-avibactam, a newer two-drug combination. Both are among the last options against bacteria that already defeat carbapenems, the class of antibiotics doctors hold in reserve for the worst infections. The authors called the fighters a potential source of global spread.The head of an investment fund for new antibiotics sees no way to contain the strains.“Superbugs know no borders, and we are already seeing evidence of drug-resistant strains associated with the war in Ukraine reaching hospitals elsewhere in Europe,” the chief executive of the AMR Action Fund, a nearly $1 billion drug industry-backed fund investing in smaller antibiotic developers, Henry Skinner, tells the Sun. “The question is not whether they will spread, but how prepared we will be when they do.”Not everyone sees that spread as inevitable. Foreign fighters, Dr. Dumchev notes, are usually evacuated through expedited routes and spend little time in Ukrainian frontline hospitals, where the resistant bacteria are mostly picked up.“It is not zero, especially for those who need longer treatment before evacuation. Even then, the risk of further spread is manageable,” he says. “These bacteria are not transmitted through the air.”Hospitals in Europe and America, he continues, routinely screen and isolate patients arriving from conflict zones until test results come back.Dr. Ginde agrees that the greatest threat sits inside hospital walls, “where these organisms can spread between patients if appropriate precautions are not taken.” Yet the Landstuhl findings show the bugs do travel.“However, we have seen documented cases of highly resistant bacteria being carried across borders by wounded soldiers receiving medical care abroad,” he says.Norway, which has taken in a significant number of infected Ukrainian soldiers, shows what containment can look like. Patients there are placed in separate rooms and isolated so the bacteria do not reach other patients.“Norway knows exactly what to do,” Mr. Outterson says. The weak link, he argues, sits further back: “a local aid station in Ukraine, where a patient stays for a week before moving on, is the setting that has a strong reservoir of these pan-resistant bacteria and cannot do much about it.”A Crisis That Predates the InvasionA 2025study in Genome Medicine found that extensively drug-resistant strains in wounded soldiers closely match strains circulating in Ukraine before the full-scale invasion. A 2023 survey by the Centers for Disease Control and Prevention and Ukrainian officials found 60 percent of patients with hospital-acquired infections carried germs resistant to carbapenems.“A lot of this resistance already existed but is being amplified by the conflict,” the founder and director of the Center for Disease Dynamics, Economics & Policy, Ramanan Laxminarayan, tells the Sun.On October 27, a new CDC report put the American toll from drug-resistant germs at 9.7 million infections and 50,800 deaths a year.Mr. Laxminarayan cautions against blaming the war alone for that toll.“The superbugs spreading in other parts of the western world do have some origin in the Ukraine conflict but are also largely driven by what is happening here, including high rates of antibiotic use, much of which is inappropriate,” he says.As a precaution, Ms. Uren wants soldiers to be given only narrow-spectrum antibiotics and to be equipped with antiseptics and clean water as standard gear. Dr. Dumchev’s team reached a similar conclusion.“Our data suggest that routine broad-spectrum antibiotics immediately after injury should be reconsidered, because they may help resistant strains take over,” he says.Whether the tents help is less settled.“Decontamination tents are designed for chemical or radioactive contamination on the body surface. These bacteria live in wounds and can colonize the body, so you can’t wash them off,” Dr. Dumchev explains.Others are not ready to write off the tents just yet.Dr. Ginde says decontamination “may help reduce spread of resistant bacteria in hospitals, but more rigorous evidence is needed.”“The most effective measures are basic infection control and prevention, including routine hand washing, contact precautions, and patient isolation or cohorting,” he adds.Mr. Laxminarayan underscores that the tents “may simply be impractical” where fighting is active, though finding out where they work is worthwhile. “We just don’t know yet.”New drugs move slowly. Because new antibiotics are reserved for use only when others fail, they are often unprofitable and many large drugmakers have abandoned the field. CARB-X, the nonprofit Mr. Outterson runs, spends about $100 million a year pushing entirely new classes of antibiotics through their first human trials.“So going from the earliest discovery at a university to drug approval takes a long time,” Mr. Outterson says.“During the Iraq war, we saw drug-resistant Acinetobacter infections emerge among wounded U.S. troops, yet it took nearly 20 years to bring a new antibiotic specifically targeting these infections to patients,” Mr. Skinner says.He is pressing Congress to pass the PASTEUR Act, reintroduced this year with bipartisan backing, to reward drugmakers for new antibiotics. “It is impossible to confront a growing superbug crisis with a shrinking antibiotic pipeline,” Mr. Skinner says.For the soldiers already fighting these infections, even the fastest timeline is too slow. “Those soldiers need a better drug now,” Mr. Outterson says. “They can’t wait 20 years.”Mr. Laxminarayan urges investment in genomic surveillance, better diagnostics inside Ukraine, and checks on travelers carrying multidrug-resistant infections.“AMR is serious,” he notes. “We just don’t behave like it is.”To Mr. Outterson, the wounded passing through Dnipro’s tents are simply a sign of the future.“These soldiers today need now the drugs that the rest of the world was going to need anyway in 20 or 30 years,” he says. “It’s a window into where we’re going.”

Ukraine Becomes World’s First ‘Post-Antibiotic War’ as Wounded Fighters Carry Superbugs Home

Ukraine Becomes World’s First ‘Post-Antibiotic War’ as Wounded Fighters Carry Superbugs Home

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