From diagnostic gap to system resilience: a new paradigm for antimicrobial resistance control in conflict-affected countries

Antimicrobial resistance (AMR) remains one of the most critical threats to global public health in 2024–2026, directly causing over 1.14 million deaths annually worldwide. Effective AMR control requires integrating three dimensions largely studied in isolation: equitable access to microbiological diagnostics, gut microbiome modulation, and health system resilience. Objective: to develop an integrated conceptual model of AMR control combining diagnostic equity, microbiome modulation, and health system resilience, with practical recommendations for conflict-affected health systems, particularly Ukraine. Methods. Systematic literature review (PubMed, Scopus, Web of Science, 2024–2026; 33 sources); WHO and CDC data analysis; synthesis of the author’s prior published research. Results. A structural diagnostic gap between LMICs and high-income countries is a key driver of empirical antibiotic overuse. The gut microbiome functions as a resistome reservoir, colonisation resistance barrier, and drug bioavailability modifier. Five critical management deficits of Ukraine’s healthcare system under biological threats were identified, and a proactive Anticipation–Adaptation–Recovery algorithm was proposed. Conclusions. Integration of diagnostic equity, microbiome surveillance, and management resilience, combined with antimicrobial stewardship programmes and digital tools, constitutes a necessary condition for effective AMR control in conflict-affected health systems.

References

1. GBD 2021 Antimicrobial Resistance Collaborators (2024) Global burden of bacterial AMR 1990–2021: a systematic analysis with forecasts to 2050. Lancet, 404(10459): 1199–1226. DOI: 10.1016/S0140-6736(24)01867-1.
2. Krishnaprasad V.H., Nayak V., Kumar S. (2025) WHO’s Bacterial Pathogen Priority List (BPPL) 2024 to combat global AMR crisis. J. Antimicrob. Chemother., 80(8): 2061–2069. DOI: 10.1093/jac/dkaf167.
3. Holubnycha V., Kholodylo A. (2025) War impact on antimicrobial resistance and bacteriological profile of wound infections in Ukraine. Commun. Med. (Lond.), 5: 394. DOI: 10.1038/s43856-025-01056-6.
4. GRAM/IHME (2023) The burden of AMR in Ukraine. Healthdata.org. Available from: healthdata.org.
5. Ehsan A. et al. (2025) Antibiotic Resistance in Developing Countries: Emerging Threats and Policy Responses. Public Health Challenges, 4(1): e70034. DOI: 10.1002/puh2.70034.
6. Kanan M. et al. (2025) Empowering LMIC to combat AMR by minimal use of antibiotics. Antibiotics (Basel), 14(1): 84. DOI: 10.3390/antibiotics14010084.
7. World Health Organization (2025) Global AMR Surveillance Report 2025. Geneva.
8. Pallett S.J.C. et al. (2025) Evolving AMR of XDR Gram-negative severe infections associated with conflict wounds in Ukraine. Lancet Reg. Health Eur. DOI: 10.1016/j.lanepe.2025.100966.
9. Frontiers (2026) Optimizing diagnostic procurement and waste management in LMIC during emerging infectious disease threats. Front. Lab. Chip Technol. DOI: 10.3389/frlct.2026.1716776.
10. Westwood E. et al. (2025) Antimicrobial resistance, equity and justice in LMIC: an intersectional critical interpretive synthesis. Nat. Commun. DOI: 10.1038/s41467-025-64137-z.
11. WHO Regional Office for Europe (2025) Building resilience in Ukraine: as full-scale war continues. WHO/Europe.
12. Gandra S. et al. (2020) Surveillance strategies using routine microbiology for AMR in LMIC. Clin. Microbiol. Infect.
13. Singh A. et al. (2024) An escape from ESKAPE pathogens: therapeutics. Eur. J. Med. Chem., 280: 116861. DOI: 10.1016/j.ejmech.2024.116861.
14. WHO (2025) 2025: A year of health security in action. WHO/Europe.
15. Gandra S., Alvarez-Uria G., Turner P. et al. (2020) AMR Surveillance in LMIC. Clin. Microbiol. Rev., 33(3): e00048-19. DOI: 10.1128/CMR.00048-19.
16. Konstantinidis T. et al. (2020) Effects of antibiotics upon the gut microbiome. Biomedicines, 8(11): 502. DOI: 10.3390/biomedicines8110502.
17. Dongre D.S., Saha U.B., Saroj S.D. (2025) Exploring the role of gut microbiota in antibiotic resistance and prevention. Ann. Med., 57(1): 2478317. DOI: 10.1080/07853890.2025.2478317.
18. The impact of antibiotic therapy on intestinal microbiota: dysbiosis, resistance and restoration strategies (2025). PMC12024230.
19. Vliex L.M.M. et al. (2024) How can the gut microbiome be targeted to fight MDR organisms? Lancet Microbe. DOI: 10.1016/j.lanmic.2024.00331-8.
20. Molecular insights into the role of gut microbiota in antibiotic therapy selection and resistance mitigation (2023). PMC10714069.
21. Vliex L.M.M., Penders J., Nauta A. et al. (2024) Individual response to antibiotics and diet — insights into gut microbial resilience. Nat. Rev. Endocrinol., 20: 387–398.
22. Kamel M. et al. (2024) Microbiome Dynamics: A Paradigm Shift in Combatting Infectious Diseases. J. Pers. Med., 14: 217. DOI: 10.3390/jpm14020217.
23. Yaqub M.O., Jain A. et al. (2025) Microbiome-Driven Therapeutics: From Gut Health to Precision Medicine. Gastrointest. Disord., 7: 7. DOI: 10.3390/gidisord7010007.
24. Peery A.F. et al. (2024) AGA clinical practice guideline on fecal microbiota-based therapies. Gastroenterology, 166(3): 409–434.
25. Preidis G.A., Versalovic J. (2025) Present and future of microbiome-targeting therapeutics. J. Clin. Invest., 135(11): e184323. DOI: 10.1172/JCI184323.
26. Ehsan A. et al. (2025) Antibiotic Resistance in Developing Countries. Public Health Challenges, 4: e70034.
27. WHO (2026) Attacks on Ukraine’s health care increased by 20% in 2025. WHO; February 2026.
28. Vartsaba Y.V., Akopyan A., Tkachenko N. (2022) Ukraine’s most vulnerable need healthcare: Priorities during the armed conflict. PLOS Med. PMC9773054.
29. CDC Ukraine office (2024–2026) CDC in Ukraine — AMR response. CDC.gov.
30. WHO Ukraine (2025) 2024 Emergency Annual Report. WHO/Europe.
31. Грицко Р.Ю. (2026) Подолання дисбалансу: мультидисциплінарний погляд на справедливість у доступі до мікробіологічної діагностики як основи ефективного громадського здоров’я та контролю антибіотикорезистентності. Грааль науки: міжнар. наук. журнал. Вінниця: ГО «Європейська наукова платформа», № 61: 998–1011.
32. Грицко Р.Ю. (2026) Мікробіом кишківника: ключовий модулятор інфекційних захворювань, ефективності ліків та нова терапевтична мішень. Theory and practice of modern science: Collection of Scientific Papers «SCIENTIA». Kraków: International Center of Scientific Research: 252–262.
33. Grytsko R. (2026) Резилієнтність системи охорони здоров’я України в умовах біологічних загроз: управлінські дефіцити та алгоритми проактивного реагування. Modern Aspects of Science, 67th volume. Česká republika: Mezinárodní Ekonomický Institut: 32–44. DOI: 10.52058/67-2026.