Bazzi Wael, Abou Fayad Antoine G, Nasser Aya, Haraoui Louis-Patrick, Dewachi Omar, Abou-Sitta Ghassan, Nguyen Vinh-Kim, Abara Aula, Karah Nabil, Landecker Hannah, Knapp Charles, McEvoy Megan M, Zaman Muhammad H, Higgins Paul G, Matar Ghassan M
Department of Experimental Pathology, Immunology and Microbiology, Faculty of Medicine, American University of Beirut, Beirut, Lebanon.
Center for Infectious Diseases Research, American University of Beirut, Beirut, Lebanon.
Front Microbiol. 2020 Feb 3;11:68. doi: 10.3389/fmicb.2020.00068. eCollection 2020.
has become increasingly resistant to leading antimicrobial agents since the 1970s. Increased resistance appears linked to armed conflicts, notably since widespread media stories amplified clinical reports in the wake of the American invasion of Iraq in 2003. Antimicrobial resistance is usually assumed to arise through selection pressure exerted by antimicrobial treatment, particularly where treatment is inadequate, as in the case of low dosing, substandard antimicrobial agents, or shortened treatment course. Recently attention has focused on an emerging pathogen, multi-drug resistant (MDRAb). MDRAb gained media attention after being identified in American soldiers returning from Iraq and treated in US military facilities, where it was termed "Iraqibacter." However, MDRAb is strongly associated in the literature with war injuries that are heavily contaminated by both environmental debris and shrapnel from weapons. Both may harbor substantial amounts of toxic heavy metals. Interestingly, heavy metals are known to also select for antimicrobial resistance. In this review we highlight the potential causes of antimicrobial resistance by heavy metals, with a focus on its emergence in in war zones.
自20世纪70年代以来，它对主要抗菌药物的耐药性日益增强。耐药性增加似乎与武装冲突有关，特别是自2003年美国入侵伊拉克后大量媒体报道放大了临床报告以来。通常认为抗菌药物耐药性是通过抗菌治疗施加的选择压力产生的，特别是在治疗不充分的情况下，如低剂量、不合格的抗菌药物或缩短治疗疗程。最近，注意力集中在一种新兴病原体——耐多药鲍曼不动杆菌（MDRAb）上。MDRAb在从伊拉克返回并在美国军事设施接受治疗的美国士兵中被发现后受到媒体关注，在那里它被称为“伊拉克杆菌”。然而，在文献中，MDRAb与被环境碎片和武器弹片严重污染的战争创伤密切相关。两者都可能含有大量有毒重金属。有趣的是，已知重金属也会导致抗菌药物耐药性。在本综述中，我们强调了重金属导致抗菌药物耐药性的潜在原因，重点关注其在战区的出现。
