The impact of armed conflict on the development and global spread of antibiotic resistance: a systematic review

Guido Granata; Eskild Petersen; Alessandro Capone; Daniele Donati; Benedetta Andriolo; Maya Gross; Stefania Cicalini; Nicola Petrosillo

doi:10.1016/j.cmi.2024.03.029

The impact of armed conflict on the development and global spread of antibiotic resistance: a systematic review

Clin Microbiol Infect. 2024 Mar 29:S1198-743X(24)00160-5. doi: 10.1016/j.cmi.2024.03.029. Online ahead of print.

Authors

Guido Granata¹, Eskild Petersen², Alessandro Capone³, Daniele Donati⁴, Benedetta Andriolo³, Maya Gross³, Stefania Cicalini³, Nicola Petrosillo⁵

Affiliations

¹ Systemic and Immune Depression-Associated Infection Unit, National Institute for Infectious Diseases "L. Spallanzani", Istituto di Ricovero e Cura a Carattere Scientifico, Roma, Italy. Electronic address: guido.granata@inmi.it.
² PandemiX Center of Excellence, Roskilde University, Roskilde, Denmark; European Society for Clinical Microbiology and Infectious Diseases Emerging Infections Subcommittee. European Society of Clinical Microbiology and Infectious Diseases, Basel, Switzerland.
³ Systemic and Immune Depression-Associated Infection Unit, National Institute for Infectious Diseases "L. Spallanzani", Istituto di Ricovero e Cura a Carattere Scientifico, Roma, Italy.
⁴ Infection Prevention & Control/Infectious Disease Service, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy.
⁵ Infection Prevention & Control/Infectious Disease Service, Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy; European Society for Clinical Microbiology and Infectious Diseases International Affairs SubCommittee. European Society of Clinical Microbiology and Infectious Diseases, Basel, Switzerland.

PMID: 38556213
DOI: 10.1016/j.cmi.2024.03.029

Abstract

Background: Scant data are available on the link between armed conflicts and the development and spread of antimicrobial resistance.

Objectives: We performed a systematic review with the aim to summarize the available data on the prevalence and features of antibiotic resistance and the causes of antibiotic resistance development during armed conflicts in the 21st century.

Methods: Data sources: PubMed and SCOPUS databases were searched from 1 January 2000 to 30 November 2023.

Study eligibility criteria: Original articles reporting data on armed conflicts and antimicrobial resistance were included in this systematic review. No attempt was made to obtain information from unpublished studies. No language restriction was applied. Methods of data synthesis: Both quantitative and qualitative information were summarized by means of textual descriptions.

Participants: Patients or soldiers deployed in armed conflict zones.

Tests: culture-dependent antibiotic sensitivity testing or molecular detection of the genetic determinants of antibiotic resistance after a confirmed diagnosis of bacterial infection. Assessment of risk of bias: To evaluate the quality of the included studies, we adapted the tool recommended by the Joanna Briggs Institute.

Results: Thirty-four studies were identified, published between November 2004 and November 2023. The quality of included studies was high and medium in 47% and 53% of the studies, respectively. The included studies reported high infection and colonization rates of multidrug-resistant bacteria. Studies performed during the Eastern Ukraine conflict reported high rates of New Delhi metallo-β-lactamase producers.

Discussion: Our findings confirm that wars lead to a large pool of multidrug-resistant infections that could potentially spread. Infection control in healthcare facilities in conflict zones and proper antimicrobial stewardship are crucial.

Keywords: Antimicrobial resistance; Antimicrobial stewardship; Armed conflicts; Extended-spectrum β-lactamase; Infection control; Methicillin-resistant Staphylococcus aureus; New Delhi metallo-β-lactamase; Spread of multidrug-resistant bacteria; Ukrainian conflict; War wounds.

Publication types

Review