Phenotypic and Genotypic Characterization of Antibiotic Resistance in Military Hospital-Associated Bacteria from War-Injuries in the Eastern Ukraine Conflict between 2014 to 2020

Objectives: To describe the phenotypic and genotypic mechanisms of antibiotic resistance in pathogens associated with war-injuries in the Ukraine conflict. Retrospective multicenter microbiological survey in four Ukrainian Military hospitals between 2014 – 2020. A total of 1,061 microbiology results with 813 organisms from 162 different patients were eligible for this study. Only 250 de-duplicated bacterial isolates were selected for further analysis. The proportion and percentage of microorganisms recovered from clinical samples from different military hospitals are described in detail in Supplementary File1. Multi-drug resistant (MDR) strains harbored an abundance of antibiotic resistant genes. K. pneumoniae co-produce class A and D β-lactamases, in one case with blaNDM-1 and rmtC 16S rRNA methyltransferase (RmtASE). A. baumannii also carried class A and D β-lactamases but not metallo-β-lactamases; in four isolates the carbapenemases were present with the RmtASE gene, armA gen. P. aeruginosa harbored wide range of class A and D β-lactamases, along with metallo-β-lactamases, singly with RmtB4 RmtASE . Gram-positive cocci were generally sensitive to tested antibiotics. The whole-genome sequences of investigated microorganisms were deposited to Genbank, the GenBank Accession Numbers can be found in Supplementary File #2. All genes which were retrieved from the genome of investigated microorganisms are listed in Supplementary File3.