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. 2025 May 20;7(3):dlaf083.
doi: 10.1093/jacamr/dlaf083. eCollection 2025 Jun.

The price of WAR: AMR

Laura J Rojas  1   2   3 , Tracy L Lemonovich  4   5 , Steven H Marshall  3 , Adam Hirschfeld  6 , Federico Perez  3   5 , Robert A Bonomo  1   2   3   5   7
Affiliations

The price of WAR: AMR

Laura J Rojas et al. JAC Antimicrob Resist. .

Abstract

Background: The ongoing conflict in Ukraine has exacerbated the risk of MDR bacterial infections in war-injured patients.

Methods: We present the case of a Ukrainian soldier who sustained a traumatic explosive injury to the bilateral lower extremities, underwent surgery and subsequently experienced an infection with a carbapenem-resistant Klebsiella pneumoniae. The isolate was subject to genomic WGS.

Results: This case study describes the successful management of a traumatic injury in a Ukrainian soldier infected with a carbapenem-resistant K. pneumoniae isolated from surgical wounds. WGS revealed a hypervirulent ST147 strain carrying multiple resistance and virulence factors, including bla NDM-1. Treatment with ceftazidime/avibactam and aztreonam was effective.

Conclusions: Ceftazidime/avibactam and aztreonam is highlighted as a promising regimen for MDR infections in conflict zones.

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Figures

Figure 1.
Figure 1.
Anterior view of right foot and ankle with external fixator in place (a) and medial view of right ankle sinus tract with drainage (b) at the time of admission. Right foot and ankle medial view (c) and lateral view (d) radiographs at the time of admission.
Figure 2.
Figure 2.
Map of blaNDM-carrying plasmid from K. pneumoniae. Highlighted in red is NDM-1 and its genetic environment, and in yellow the origin of replication.
See this image and copyright information in PMC

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