Russia’s full-scale invasion of Ukraine has transformed both the modern battlefield and the microbial environment surrounding the war-wounded. Explosive injuries, prolonged evacuation, and limited opportunities for early decontamination have contributed to an unprecedented rise in multidrug-resistant organism (MDRO) infections. This paper describes how routine infection prevention and control (IPC) and antimicrobial stewardship (AMS) systems have become inadequate under conflict conditions and how contamination evolves into colonization and then systemic infection as casualties move through the evacuation pathway. Building on the national IPC and AMS strengthening, we outline a complementary crisis intervention: the application of chemical, biological, radiological, and nuclear-inspired decontamination principles to routine trauma care. These measures incorporate structured early irrigation and debridement, antiseptic cleansing, removal of contaminated materials, and the use of dedicated decontamination spaces at hospital entry. They
are designed to reinforce existing programs by reducing microbial burden at the earliest point of contact. Implementing this approach aims to disrupt MDRO acquisition and transmission, protect fragile healthcare infrastructure, and mitigate escalating biosecurity risks. Ukraine’s conflict experience has informed the
development of this proposed concept, with formal implementation and impact evaluation planned as thenext phase of work.

In 2023, two Correspondence published in The Lancet Infectious Diseases highlighted the growing apprehension regarding extensively drug-resistant bacteria originating from Ukraine, exacerbated by the ongoing conflict.1,2 However, there is a paucity of large granular and localised datasets to substantiate and guide international response efforts.
We report on this crucial gap by presenting findings from over 6800 diagnostic isolates obtained from the largest health-care union in Western Ukraine collated as part of development of a yearly cumulative antibiogram (CuAbgm) to track antibiotic-resistant bacteria in our region; the study period took place between May 1, 2023, and April 30, 2024. Hospitals within the First Lviv Territorial Medical Union (1TMO) contain over 2400 beds and provide treatment for more than 100 000 patients annually. 1TMO is an essential hospital union in the trauma evacuation pathway, receiving war-wounded casualties for definitive reconstruction surgery and burns treatment from other Ukrainian hospitals.