International Committee of the Red Cross (ICRC), Geneva, Switzerland.
International Committee of the Red Cross (ICRC), Beirut, Lebanon.
BMC Infect Dis. 2022 Mar 14;22(1):257. doi: 10.1186/s12879-022-07253-1.
A substantial body of evidence has recently emphasized the risks associated with antibiotic resistance (ABR) in conflicts in the Middle East. War-related, and more specifically weapon-related wounds can be an important breeding ground for multidrug resistant (MDR) organisms. However, the majority of available evidence comes from the military literature focused on risks and patterns of ABR in infections from combat-related injuries among military personnel. The overall aim of this study is to contribute to the scarce existing evidence on the burden of ABR among patients, including civilians with war-related wounds in the Middle East, in order to help inform the revision of empirical antibiotic prophylaxis and treatment protocols adopted in these settings. The primary objectives of this study are to: 1) describe the microbiology and the corresponding resistance profiles of the clinically relevant bacteria most commonly isolated from skin, soft tissue and bone biopsies in patients admitted to the WTTC; and 2) describe the association of the identified bacteria and corresponding resistance profiles with sociodemographic and specimen characteristics.
We retrospectively evaluated the antibiograms of all consecutive, non-duplicate isolates from samples taken from patients admitted to the ICRC WTTC between 2016 and 2019, limited to skin and soft tissue samples and bone biopsies. We collected data on socio-demographic characteristics from patient files and data on specimens from the WHONET database. We ran univariate and multivariable logistic regression models to test the association between bacterial and resistance profiles with sociodemographic and specimen characteristics.
Patients who were admitted with war-related trauma to the ICRC reconstructive surgical project in Tripoli, Lebanon, from 2016 to 2019, presented with high proportion of MDR in the samples taken from skin and soft tissues and bones, particularly Enterobacterales (44.6%), MRSA (44.6%) and P. aeruginosa (7.6%). The multivariable analysis shows that the odds of MDR isolates were higher in Iraqi patients (compared to Syrian patients) and in Enterobacterales isolates (compared to S. aureus isolates).
Our findings stress the importance of regularly screening patients who present with complex war-related injuries for colonization with MDR bacteria, and of ensuring an antibiotic-sensitivity testing-guided antimicrobial therapeutic approach.
最近有大量证据强调了在中东冲突中与抗生素耐药性（ABR）相关的风险。与战争相关的、更具体地说是与武器相关的伤口可能是多药耐药（MDR）生物体的重要滋生地。然而，大多数现有证据来自于军事文献，重点关注军事人员因战斗相关伤害而感染的 ABR 风险和模式。本研究的总体目标是为中东与战争相关的伤口的患者中 ABR 的负担提供稀缺的现有证据，以帮助为这些环境中采用的经验性抗生素预防和治疗方案的修订提供信息。本研究的主要目的是：1）描述从 2016 年至 2019 年入住 ICRC 创伤治疗中心（WTTC）的患者的皮肤、软组织和骨活检中最常分离出的临床相关细菌的微生物学和相应的耐药谱；2）描述所鉴定的细菌和相应的耐药谱与社会人口统计学和标本特征的关联。
我们回顾性评估了 2016 年至 2019 年期间从入住 ICRC WTTC 的患者的连续、非重复样本中分离出的所有抗生素药敏谱，并将其限制在皮肤和软组织样本以及骨活检中。我们从患者档案中收集社会人口统计学特征的数据，并从 WHONET 数据库中收集标本数据。我们进行了单变量和多变量逻辑回归模型来测试细菌和耐药谱与社会人口统计学和标本特征的关联。
2016 年至 2019 年期间，从在黎巴嫩的黎波里的 ICRC 重建外科项目中因战争创伤而入院的患者，其皮肤和软组织以及骨骼标本中分离出的 MDR 比例较高，尤其是肠杆菌科（44.6%）、耐甲氧西林金黄色葡萄球菌（44.6%）和铜绿假单胞菌（7.6%）。多变量分析表明，与叙利亚患者相比，伊拉克患者（与叙利亚患者相比）和肠杆菌科分离株（与金黄色葡萄球菌分离株相比）的 MDR 分离株的可能性更高。
我们的研究结果强调了定期筛查患有复杂战争相关损伤的患者是否存在 MDR 细菌定植的重要性，以及确保基于抗生素敏感性测试的抗菌治疗方法的重要性。
