Antimicrobial resistance in a war-torn country: Lessons learned in the Eastern Democratic Republic of the Congo.

There is no doubt that antibiotics have reduced the burden of bacterial infectious diseases. Antimicrobial resistance threatens the effectiveness of successful treatment of infections and constitutes a public health concern with national and global dimensions. This problem is worrisome in war-torn areas like the Eastern Democratic Republic of the Congo. The difficulties experienced by war-torn nations in addressing antimicrobial resistance are significant for the rest of the globe as microbes do not acknowledge boundaries and do not distinguish between peace and wartime. In this paper, we describe the impact of warfare on the social determinants of health, the environment and biodiversity, and its consequences on the antibiotic use and the host-pathogen interplay. Furthermore, we describe different pillars to be taken into account, learned in a war-torn area, in combating antimicrobial resistance. These lessons are summarized in terms of tools to be used for combating antimicrobial resistance, challenges to overcome in war-torn setting and core actions to be undertaken. Surveillance is a valuable tool to combat antimicrobial resistance as it helps to detect resistant bacteria, enables correct decisions to be taken, guides policy recommendations and tracks the antibiotic use and misuse. The challenges encountered in this region include the shortage of competent laboratories, poor infrastructure and data management, lack of standard protocols, low coverage of surveillance, lack of intersectoral cooperation, and inadequate national, regional and international collaboration. Regarding this situation, the core actions to be undertaken include the establishment of ABR surveillance and monitoring systems, building laboratory capacity for rapid and reliable diagnostic testing, and engagement in national, regional and global surveillance networks. Therefore, this study showed an urgent need for establishing and implementing sentinel site surveillance laboratories and elaborating and implementing national action plans for combating antimicrobial resistance.