The contribution of human conflict to the development of antimicrobial resistance

Pallett, Scott J. C.; Boyd, Sara E.; O’Shea, Matthew K.; Martin, Jessica; Jenkins, David R.; Hutley, Emma J.

doi:10.1038/s43856-023-00386-7

Cited by 6 publications

(4 citation statements)

References 21 publications

(50 reference statements)

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“… 1 However, this rate varied significantly among species, with a 2022 WHO/ECDC study of Ukraine indicating that carbapenem resistance varied from 4% in Escherichia coli to 53.3% in Klebsiella pneumoniae in 2020 ( https://www.ecdc.europa.eu/sites/default/files/documents/Joint-WHO-ECDC-AMR-report-2022.pdf ) Recently, a Ukrainian-led international collaboration identified multiple challenges in controlling MDROs and healthcare-associated infections (HAIs), including inadequate surveillance and infection prevention, 2 but the onset of the invasion has greatly exacerbated the problem. 3 Notably, these observations reflect previous trends from armed conflicts in Afghanistan, Syria 4 and Iraq, 5 where MDRO infections increased significantly in military and civilian populations.…”

Section: Introductionsupporting

confidence: 74%

Phenotypic and genomic analysis of bacteria from war wounds in Dnipro, Ukraine

Stepanskyi,

Ishchenko,

Luo

et al. 2024

JAC-Antimicrobial Resistance

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Objectives To better understand the source and potential transmission routes of antibiotic-resistant bacteria infecting injured service members in Ukraine. Methods Phenotypic and genomic characterizations were performed on 11 Gram-negative pathogens cultured from war wounds at an intermediate evacuation hospital in Dnipro. Results The analysis revealed both susceptible and extensively drug-resistant strains present in cultures, including high-risk global clones carrying carbapenemases. Conclusions Globally distributed carbapenemase-producing lineages are being acquired early in the medical evacuation process.

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Section: Introductionsupporting

confidence: 74%

Phenotypic and genomic analysis of bacteria from war wounds in Dnipro, Ukraine

Stepanskyi,

Ishchenko,

Luo

et al. 2024

JAC-Antimicrobial Resistance

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“…The healthcare system has been destroyed by the ongoing conflict. 16 Evidence shows that conflict has the potential to accelerate and spread AMR locally and globally, 17 and we are therefore committed to re-establishing the S-AMR group, and continue building the capacity for research, surveillance and supporting intervention-based studies, when the situation allows.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic resistance in Sudan: assessing the knowledge and practices of healthcare workers in Khartoum

Osman,

Omer,

Elmubarak

et al. 2024

JAC-Antimicrobial Resistance

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Background Antibiotic resistance (ABR) is a major public health issue, associated with increased patient morbidity and mortality globally, with significantly higher rates in low- and middle-income countries (LMICs). Assessment of contextual factors, such as information, education, infrastructure and regulations are important for developing local solutions against ABR. Objectives To determine the knowledge and practices of healthcare workers (HCWs) towards ABR in hospitals in Sudan. Materials and methods A survey was conducted in three different hospitals in Khartoum, Sudan from February to December 2020. HCWs of different specialties and expertise were invited to participate. Data were descriptively analysed using Statistical Package for Social Sciences (SPSS). Results ABR was identified as a big challenge by 89% of 345 HCWs who participated. The results show that 79% of doctors don’t rely on the clinical microbiology laboratory (CML) results for antibiotic prescription or clinical decision-making. Sixty percent of HCWs agreed there are infection prevention and control (IPC) guidelines in their hospital, but 74% of them don’t have access to them, and infrequently receive relevant IPC training. Furthermore, HCWs obtain ABR information from other colleagues informally, not through local data or reports. Conclusions Despite adequate knowledge of ABR locally, there are significant contextual technical challenges facing HCWs in Sudan, such as availability of policies and accurate data from CMLs. The results indicate a poor link between HCWs and the CMLs for infection management and it is essential to improve communication between the different hospital departments with regard to ABR transmission, and ensure the effectiveness of local IPC policies based on locally available data.

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“…Many factors contribute to the spread of AMR, including the poor medication quality (such as counterfeit production), inappropriate prescription practices, patient misuse of antibiotics, inadequate surveillance systems and tests for AMR, and overuse of antibiotics in the industrial, animal, and agricultural sectors [4]. Wars and conflicts also play a crucial role in contributing to this grave situation [5]. Last, but not least, during the coronavirus disease 2019 pandemic, there was a surge in the incorrect overuse of antibiotics [6].…”

Section: Introductionmentioning

confidence: 99%

Molecular Mechanisms of Bacterial Resistance to Antimicrobial Peptides in the Modern Era: An Updated Review

Tajer,

Paillart,

Dib

et al. 2024

Microorganisms

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Antimicrobial resistance (AMR) poses a serious global health concern, resulting in a significant number of deaths annually due to infections that are resistant to treatment. Amidst this crisis, antimicrobial peptides (AMPs) have emerged as promising alternatives to conventional antibiotics (ATBs). These cationic peptides, naturally produced by all kingdoms of life, play a crucial role in the innate immune system of multicellular organisms and in bacterial interspecies competition by exhibiting broad-spectrum activity against bacteria, fungi, viruses, and parasites. AMPs target bacterial pathogens through multiple mechanisms, most importantly by disrupting their membranes, leading to cell lysis. However, bacterial resistance to host AMPs has emerged due to a slow co-evolutionary process between microorganisms and their hosts. Alarmingly, the development of resistance to last-resort AMPs in the treatment of MDR infections, such as colistin, is attributed to the misuse of this peptide and the high rate of horizontal genetic transfer of the corresponding resistance genes. AMP-resistant bacteria employ diverse mechanisms, including but not limited to proteolytic degradation, extracellular trapping and inactivation, active efflux, as well as complex modifications in bacterial cell wall and membrane structures. This review comprehensively examines all constitutive and inducible molecular resistance mechanisms to AMPs supported by experimental evidence described to date in bacterial pathogens. We also explore the specificity of these mechanisms toward structurally diverse AMPs to broaden and enhance their potential in developing and applying them as therapeutics for MDR bacteria. Additionally, we provide insights into the significance of AMP resistance within the context of host–pathogen interactions.

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The contribution of human conflict to the development of antimicrobial resistance

Abstract: Human conflict, such as the ongoing conflict in Ukraine, is an important driver of antimicrobial resistance. Here, we describe the challenges when addressing this problem during an ongoing conflict and the opportunities available to reduce the spread of antimicrobial resistance.

Cited by 6 publications

References 21 publications

Phenotypic and genomic analysis of bacteria from war wounds in Dnipro, Ukraine

Phenotypic and genomic analysis of bacteria from war wounds in Dnipro, Ukraine

Antibiotic resistance in Sudan: assessing the knowledge and practices of healthcare workers in Khartoum

Molecular Mechanisms of Bacterial Resistance to Antimicrobial Peptides in the Modern Era: An Updated Review

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