ArticleInfectious diseases of poverty2025
Antimicrobial resistance surveillance and trends in armed conflict, fragile, and non-conflict countries of the Eastern Mediterranean Region.
Article in Infectious diseases of poverty, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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14 citing papers in PubMed.
- A systematic review of antimicrobial resistance among World Health Organization Bacterial Priority Pathogens in Syria (2015-2025).IJID regions · 2026Article
- Paleopathology Meets Public Health: Deep-Time Syndemics and the Ecology of Emerging Infections.Pathogens (Basel, Switzerland) · 2026Review
- Global threats in local wards: Dissemination of high-risk clones resistant to last-generation cephalosporins and carbapenems in Iraqi hospitals.IJID regions · 2026Article
- Antimicrobial-Resistant Infections in the Eastern Mediterranean Region (EMR): Burden, Mortality Trends, and Progress Toward AMR Reduction Milestones (2013-2023).Health services insights · 2026Article
- Antimicrobial Resistance in Somalia: A Silent Public Health Crisis Demanding Immediate Action.Infection and drug resistance · 2026Article
- Evidence of transmission and dissemination of diverseApplied and environmental microbiology · 2025Article
- Combating antimicrobial resistance in Asia: A comprehensive review of strategic action plans, policies, and the role of the WHO.Saudi medical journal · 2025Review
- Syria's intersecting crises exacerbate antimicrobial resistance.npj antimicrobials and resistance · 2025Article
- A One Health Comparative Study of MDRAntibiotics (Basel, Switzerland) · 2025Article
- A nationwide cross-sectional study of antimicrobial resistance in Palestinian hospitals: insights from 10,000 clinical isolates.Antimicrobial resistance and infection control · 2025Article
- Gaza's health emergency: impact of armed conflict and its global health repercussions.Globalization and health · 2025Article
- Utilization of a Multi-Tissue Extracellular Matrix in Complex Wound Care in Gaza: A Case Series.Antibiotics (Basel, Switzerland) · 2025Article
- Comprehensive narrative analysis of antimicrobial resistance in Afghanistan: key drivers, challenges, and strategic interventions.Journal of health, population, and nutrition · 2025Review
- Antimicrobial resistance in the Eastern Mediterranean Region: experiences, challenges, and perspectives.Frontiers in public health · 2025Article
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Abstract
backgroundThe WHO Eastern Mediterranean Region (EMR) faces major social, economic, and demographic challenges, with nearly half of its countries affected by conflicts that severely disrupt health systems. This study compared antimicrobial resistance (AMR) rates and surveillance efforts in conflict-affected, fragile, and non-conflict countries, further subdivided by income.
methodsData on bacteriologically confirmed bloodstream infections (BC-BSIs) from 2017 to 2021 were extracted from the WHO GLASS database. Countries were classified as conflict-affected, fragile, or non-conflict (subdivided by income) using World Bank criteria. Descriptive statistics (mean ± SD) were calculated, and group comparisons were performed using unpaired t-tests with Welch's correction. Mean differences (MD) and 95% confidence intervals (CI) were reported.
resultsConflict-affected countries reported significantly fewer surveillance sites than non-conflict countries (MD: 0.60, 95% CI: 0.361 to 0.836, P < 0.001) and fewer BC-BSIs per million population (MD: 31.00, 95% CI: 17.210 to 44.790, P < 0.001). In conflict zones, Acinetobacter spp. and S. aureus represented a higher proportion of BSIs compared to non-conflict countries (Acinetobacter spp. MD: -11.86, 95% CI: - 27.130 to 3.399, P = 0.099; S. aureus MD: - 10.68, 95% CI: - 30.030 to 8.680, P = 0.203). Carbapenem resistance in Acinetobacter spp. exceeded 65% across the groups, peaking in fragile zones (83.38%). Third-generation cephalosporin-resistant E. coli (3GCREC) prevalence ranged from 47.99% to 76.34%, peaking in conflict zones (76.34%). Carbapenem-resistant E. coli (CREC) prevalence ranged from 2.31% to 15.95%, highest in non-conflict low-middle income countries (15.95%). Third-generation cephalosporin-resistant K. pneumoniae (3GCRKP) exceeded 50% in all groups, peaking in conflict zones (80.42%). The prevalence of carbapenem-resistant K. pneumoniae (CRKP) ranged from 14.49% to 45.70%, peaking in conflict zones and non-conflict low-middle income countries (45.70%). Methicillin-resistant S. aureus (MRSA) exceeded 30%, peaking in conflict zones (70.09%).
conclusionsConflict-affected countries have weaker AMR surveillance and lower BC-BSI detection but a higher burden of resistant pathogens, notably carbapenem-resistant Acinetobacter spp. and MRSA. Tailored strategies are essential to restore infrastructure, strengthen surveillance, and mitigate the long-term impact of AMR in these zones.
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