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Combating Antimicrobial Resistance Amidst War: A Pioneering Effort by Columbia University Mailman School of Public Health in Ukraine

In the aftermath of the Russian invasion of Ukraine in February of 2022, experts from the global public health community were cognizant of one pending invisible crisis that the country and its neighboring regions were about to face, in addition to the evident destruction and casualties caused by war. This silently looming crisis was the rapid spread of antimicrobial resistance (AMR) in the victims of war. In response to this, ICAP, an entity from Columbia University Mailman School of Public Health, initiated an unprecedented curated project to combat AMR in Ukraine. ICAP was backed by funding from the CDC. The project was centered around minimizing the spread of drug-resistant bacteria that resulted from the mass casualties of the conflict. To underline the specific implementation of the project, ICAP extended assistance to three acute care hospitals, each with in-house laboratories, and three standalone laboratories with necessary resources to deal with the escalated volume of war victims.

It is noteworthy that ICAP is the solo organization leading this mission in Ukraine. The Columbia University Mailman School of Public Health, founded in 1922 with a mission to address critical public health issues, is globally recognized for its effective strategies in combating infectious and chronic diseases, environmental health issues, health policies, climate change impacts on health, and public health preparedness. The School has an extensive network of almost 300 interdisciplinary faculty members working in over 100 countries worldwide. It continues to lead public health education and hosts several acclaimed research centers such as ICAP and the Center for Infection and Immunity. On a global scale, AMR has been a significant cause for concern, claiming more lives than HIV or malaria, thus leading the World Health Organization (WHO) to list it among the top ten threats to public health.

The transmission of AMR primarily involves human interaction and contact with animals or the environment, with health care settings being significant contributors to its spread. War times have always led to an overwhelming influx of wounded patients, putting immense strain on the health care system. This, coupled with deteriorated infection prevention control protocols and antibiotic prescription practices, provides a conducive breeding ground for multidrug-resistant microbes to thrive. Health regions like Ukraine, which have historically had higher death rates attributed to AMR infection, witness an exacerbation of the situation during conflicts, such as following past wars involving US servicemen in Iraq and Afghanistan. This led to the emergence of the ‘signature’ strain of bacteria, Acinetobacter baumannii, due to the Iraq war. The ongoing conflict in Ukraine has also resulted in the outbreak of its signature strain, Klebsiella pneumoniae.

In 2022 when war broke out, with support from the CDC, ICAP undertook the task of reinforcing AMR surveillance, prevention, and cure in three critical hospitals in central Ukraine. These facilities were receiving and treating casualties from the war. Subsequently, these health facilities began facing an influx of casualties equivalent to a weekly mass casualty event. ICAP’s initiatives also included providing state-of-art equipment to seven laboratories to enhance their diagnostic and identification facilities. It was observed that the AMR testing capacity of these labs improved by an average of 22 percent since the inception of the project. ICAP also hosts bi-weekly interactions with physicians, epidemiologists, infection prevention control representatives, bacteriologists, and pharmacists from these facilities to address challenging cases and provide regular updates and training on various topics.

As part of these interactions, US military doctors have also shared their experiences with implementing infection control measures during prior combat operations. ICAP also aims to integrate a bundle of infection control interventions similar to the ones adopted during the Iraq war to control the spread of resistant organisms. The sequential plan undertaken by ICAP includes colonization screening, a strategy involving the screening of everyone entering certain units in the hospitals for resistant organisms, as not all carriers display symptoms. As part of its ongoing mission in Ukraine, ICAP has plans to extend its program to more hospitals housing labs similar to the ones it is currently working with.


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