Kumar Ramya, Tanous Osama, Mills David, Wispelwey Bram, Asi Yara, Hammoudeh Weeam, Dewachi Omar
University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA.
FXB Center for Health and Human Rights, Harvard University, Boston, Massachusetts, USA.
mSystems. 2025 Jun 17;10(6):e0167924. doi: 10.1128/msystems.01679-24. Epub 2025 May 21.
Antimicrobial resistance (AMR) is an escalating global health crisis. In war-affected regions, where healthcare systems are already compromised, AMR presents an even greater threat. The occupied Palestinian territories (oPt), subjected to chronic war-like conditions, have experienced extensive fragmentation, de-development, and destruction of healthcare. This review maps the existing knowledge regarding AMR carriage and infection in the oPt. We conducted a scoping review using PubMed, CINAHL, Embase, and Web of Science. Findings on the prevalence and suggested drivers of AMR were extracted and analyzed according to the One Health approach. From an initial 1,787 articles, 102 were included in the final analysis. Of these, 91 studies focused on AMR in humans, seven on animals, and four on water contamination. The findings reveal high rates of AMR, with 40% of producing extended-spectrum beta-lactamase (ESBL) and 55% of resistant to penicillin. Additionally, 45.6% of isolates from cow milk were methicillin-resistant, and 36% of chicken samples contained carbapenem-resistant gram negative bacteria. Significant gaps in the regulation of antibiotic prescription, dispensation, and consumption were reported. Despite the heterogeneity in reporting methods across studies and the inability to perform a meta-analysis, the evidence suggests alarmingly high AMR rates within the oPt. Notably, most studies attributed AMR to local practices, often overlooking broader structural and socio-political drivers. This review underscores the need to contextualize AMR within the environment, particularly under conditions of sustained warfare.IMPORTANCEThis study goes beyond merely reviewing and summarizing data on AMR in the occupied Palestinian territories (oPt), a region enduring chronic war-like conditions. Our work addresses critical gaps in knowledge about AMR in populations affected by war and siege. By contextualizing AMR through a socio-political lens, this study offers a novel perspective. It highlights deeper drivers, including the impact of war on the behaviors and education of patients and doctors, perceptions of antibiotics, the role of humanitarian interventions in fostering antibiotic anarchy, and the overall weakening of the Palestinian healthcare system. Importantly, this review also sets the stage for understanding the existing literature on AMR in the oPt within the context of the ongoing war in Gaza, emphasizing the immediate need for comprehensive strategies to address AMR under conditions of conflict. The insights can inform physicians and policymakers in designing and implementing effective AMR stewardship programs, not only in Palestine but also in other conflict-affected regions.
抗菌药物耐药性（AMR）是一场不断升级的全球健康危机。在受战争影响的地区，医疗系统本已受到损害，AMR构成的威胁更大。被占领巴勒斯坦领土（oPt）长期处于类似战争的状态，医疗保健出现了广泛的碎片化、倒退和破坏。本综述梳理了关于oPt地区AMR携带情况和感染的现有知识。我们使用PubMed、CINAHL、Embase和Web of Science进行了一项范围综述。根据“同一健康”方法提取并分析了关于AMR流行率及推测驱动因素的研究结果。从最初的1787篇文章中，最终纳入分析的有102篇。其中，91项研究聚焦于人类的AMR，7项研究动物的AMR，4项研究水污染。研究结果显示AMR发生率很高，40%的[具体对象]产生超广谱β-内酰胺酶（ESBL），55%的[具体对象]对青霉素耐药。此外，牛奶中分离出的[具体对象]有45.6%对甲氧西林耐药，鸡肉样本中有36%含有耐碳青霉烯革兰氏阴性菌。报告称在抗生素处方、配药和使用的监管方面存在重大差距。尽管各研究报告方法存在异质性，且无法进行荟萃分析，但证据表明oPt地区AMR发生率高得惊人。值得注意的是，大多数研究将AMR归因于当地做法，往往忽视了更广泛的结构和社会政治驱动因素。本综述强调需要将AMR置于特定环境中，尤其是在持续战争的条件下。
重要性
本研究不仅仅是回顾和总结被占领巴勒斯坦领土（oPt）这一长期处于类似战争状态地区的AMR数据。我们的工作填补了受战争和围困影响人群中AMR知识的关键空白。通过社会政治视角将AMR置于特定环境中，本研究提供了一个新视角。它突出了更深层次的驱动因素，包括战争对患者和医生行为及教育的影响、对抗生素的认知、人道主义干预在助长抗生素无政府状态方面的作用，以及巴勒斯坦医疗系统的整体削弱。重要的是，本综述还为在加沙持续战争背景下理解oPt地区AMR的现有文献奠定了基础，强调了在冲突条件下迫切需要全面战略来应对AMR。这些见解可为医生和政策制定者设计和实施有效的AMR管理计划提供参考，不仅在巴勒斯坦，也在其他受冲突影响的地区。
